Comparison of open acromioplasty, arthroscopic acromioplasty and physiotherapy in patients with subacromial impingement syndrome: a prospective randomised study

Knee Surg Sports Traumatol Arthrosc. 2016 Jul;24(7):2181-91. doi: 10.1007/s00167-014-3416-4. Epub 2014 Nov 11.


Purpose: To compare the results two to three years after intervention, using either surgical or non-operative treatment.

Methods: Eighty-seven patients with subacromial impingement syndrome (SAIS) were randomised into open acromioplasty (OS group), arthroscopic acromioplasty (AS group) or physiotherapy (PT group) treatment. The assessments comprised the Constant score, the Watson and Sonnabend score, the SF-36 evaluation and a clinical examination performed by an independent observer. Fifty-five patients attended the clinical follow-up.

Results: The groups were comparable at baseline in terms of demographics and clinical assessments. No significant differences in terms of the clinical assessments or health-related quality of life (QoL) were found between the study groups at follow-up. The Constant score had improved significantly at follow-up in both the OS group and the AS group (p = 0.003 and 0.008, respectively). At follow-up, the OS group revealed improved strength compared with before intervention (p = 0.012). All groups revealed a significantly improved internal rotation (OSG p = 0.01, ASG p = 0.005, PTG p = 0.004). The SF-36 was significantly improved in some scales within all three groups. The Watson and Sonnabend score was significantly improved in 12/14 questions for the OS group, in 5/14 questions for the AS group and in 6/14 for the PT group (p < 0.02 OS group vs. AS group, p < 0.05 OS group vs. PT group).

Conclusion: In this randomised study, the Constant score, other clinical assessments and subjective health-related QoL revealed no significant differences between the 3 groups two to three years after intervention in patients with SAIS. The OS group showed a greater improvement over time.

Level of evidence: CT with low follow-up rate, Level II.

Keywords: Physiotherapy; RCT; Subacromial impingement syndrome; Surgical treatment.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acromion / surgery*
  • Adult
  • Aged
  • Arthroscopy*
  • Decompression, Surgical
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscle Strength
  • Physical Therapy Modalities*
  • Prospective Studies
  • Quality of Life
  • Rotation
  • Shoulder Impingement Syndrome / therapy*