This randomised controlled trial tested whether arthroscopic acromioplasty adds value beyond supervised exercise for stage II shoulder impingement syndrome. 140 patients who had already failed conservative treatment were randomised to exercise alone or surgery plus the same exercise programme. The primary outcome was self-reported VAS pain at 24 months.
When a patient with stage II impingement has failed rest, NSAIDs, subacromial injections, and physiotherapy, the reflex is to offer acromioplasty. This trial argues against that reflex.
Crucially, these were the very patients you would consider surgical candidates: mean symptom duration 2.5 years, and 59% had already had steroid injections. Even in this failed-conservative group, adding surgery produced no clinically important benefit over a structured, supervised exercise programme at two years.
The mental model: most recovery comes from the natural course plus dedicated exercise, not from removing bone. Surgery sped early recovery but the exercise group caught up by 24 months.
Apply this by treating supervised exercise as the foundation, and reserving acromioplasty for clear indications, which the authors state have not yet been established. The surgical arm cost about 60% more with no reliable outcome advantage.
This randomised controlled trial tested whether arthroscopic acromioplasty adds value beyond supervised exercise for stage II shoulder impingement syndrome. 140 patients who had already failed conservative treatment were randomised to exercise alone or surgery plus the same exercise programme. The primary outcome was self-reported VAS pain at 24 months.
When a patient with stage II impingement has failed rest, NSAIDs, subacromial injections, and physiotherapy, the reflex is to offer acromioplasty. This trial argues against that reflex.
Crucially, these were the very patients you would consider surgical candidates: mean symptom duration 2.5 years, and 59% had already had steroid injections. Even in this failed-conservative group, adding surgery produced no clinically important benefit over a structured, supervised exercise programme at two years.
The mental model: most recovery comes from the natural course plus dedicated exercise, not from removing bone. Surgery sped early recovery but the exercise group caught up by 24 months.
Apply this by treating supervised exercise as the foundation, and reserving acromioplasty for clear indications, which the authors state have not yet been established. The surgical arm cost about 60% more with no reliable outcome advantage.