Open acromioptasty does not prevent the progression of an impingement syndrome to a tear - Nine-year follow-up of 96 cases

We performed open acromioplasty for intractable impingement syndrome on 96 shoulders (93 patients) with an intact rotator cuff. All the shoulders were examined by ultrasound after a mean interval of nine years. Those showing pathological findings, a poor or fair subjective result, or deterioration o f the primacy excellent outcome had MRI and/or arthrography. The mean Constant score for the affected shoulders was 70 points and that f or 48 non-involved, symptom-free shoulders, 84 points. The subjective outco me was excellent in 45, good in 24, fair in 18 and poor in 9 shoulders, Com plete tears were found in 12 shoulders and partial tears in seven, A total of 14 shoulders was symptom-free after acromioplasty, but after an average of five years became painful again and showed deterioration. Of these, six had complete tears and four partial tears of the cuff. The tear rate was 4% in shoulders initially judged to be excellent, 25% in good, 33% in fair an d 55% in poor shoulders. The tear rate was 71% in shoulders which subsequen tly deteriorated, The incidence was higher in men (25%) than in women (11%) . We conclude that a tear of the rotator cuff may appear after acromioplasty, although there was no evidence of a tear at the time of operation, This is usually the reason for deterioration in a shoulder with an initially good operative outcome.