Comparison of arthroscopic and open revision decompression for failed anterior acromioplasty

Thirty-six consecutive patients who underwent revision decompression for refractory subacromial impingement were studied retrospectively. Average interval from the primary decompression procedure to revision was 29 months. Eighteen patients underwent arthroscopic and 18 underwent open revision. Six (33%) patients in the arthroscopic group and 12 (67%) patients in the open group were workers' compensation cases. At an average follow-up of 26 months, 17 (94%) patients in the arthroscopic group and 8 (44%) in the open group were satisfied with their procedure. Comparing workers' compensation patients, 5 of 6 in the arthroscopic group and 4 of 12 in the open group were satisfied. For nonworkers' compensation patients, all 12 patients in the arthroscopic group and 4 of 6 in the open group were satisfied. Average pain scores and postoperative range of motion was improved in both groups. Dense subacromial scarring with thick, fibrous adhesions was present in all patients. Residual, prominent bone, or an acromial spur was found in 20 (56%) patients. Overall, revision arthroscopic subacromial decompression was superior to open revision. However, there were more workers' compensation patients in the open group. Workers' compensation patients fared worse for both groups, but a significant proportion (83%) of the arthroscopic group was satisfied. Since subacromial scarring may be the most important pathology, arthroscopy is less invasive, allowing earlier, unrestricted postoperative rehabilitation and proving more effective.