A single-surgeon randomized trial testing whether adding arthroscopic subacromial decompression to rotator cuff repair improves outcomes. Patients with an isolated full-thickness supraspinatus tear and a type 2 acromion were randomized to repair with or without decompression. The question: does removing the acromion actually help, or is it a habit carried over from the open era?
For an isolated supraspinatus tear with a type 2 acromion, you do not need to add subacromial decompression to get a good result from arthroscopic repair.
This matters because acromioplasty was long done reflexively, on the assumption that a prominent acromion drives cuff disease. The data here support a different model: the tendon fails from intrinsic degeneration and eccentric overload, so shaving bone does not address the actual problem.
Read the limits carefully before generalizing. This applies only to type 2 acromions and single-tendon tears. Type 3 (hooked) acromions were excluded, so this trial says nothing about them.
One strength worth noting for critical appraisal: the study was powered at 99.5% to catch a 7-point ASES difference, so a truly negative finding is believable. Know the acromial types for the OITE: type 1 flat, type 2 curved, type 3 hooked, assessed on the supraspinatus outlet view.
A single-surgeon randomized trial testing whether adding arthroscopic subacromial decompression to rotator cuff repair improves outcomes. Patients with an isolated full-thickness supraspinatus tear and a type 2 acromion were randomized to repair with or without decompression. The question: does removing the acromion actually help, or is it a habit carried over from the open era?
For an isolated supraspinatus tear with a type 2 acromion, you do not need to add subacromial decompression to get a good result from arthroscopic repair.
This matters because acromioplasty was long done reflexively, on the assumption that a prominent acromion drives cuff disease. The data here support a different model: the tendon fails from intrinsic degeneration and eccentric overload, so shaving bone does not address the actual problem.
Read the limits carefully before generalizing. This applies only to type 2 acromions and single-tendon tears. Type 3 (hooked) acromions were excluded, so this trial says nothing about them.
One strength worth noting for critical appraisal: the study was powered at 99.5% to catch a 7-point ASES difference, so a truly negative finding is believable. Know the acromial types for the OITE: type 1 flat, type 2 curved, type 3 hooked, assessed on the supraspinatus outlet view.