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Failed acromioplasty for impingement syndrome
D J Ogilvie-Harris1, A M Wiley, J Sattarian
1Toronto Hospital, Ontario, Canada.
The Journal of Bone and Joint Surgery. British Volume
|November 1, 1990
Summary
Many patients experience persistent shoulder pain after acromioplasty due to diagnostic or surgical errors. Successful revision surgery rates were significantly lower for those receiving worker's compensation.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Shoulder Arthroscopy
Background:
- Persistent shoulder pain and dysfunction after initial acromioplasty for impingement syndrome are common.
- Rotator cuff integrity is crucial, but this study focuses on cases without initial tears.
Purpose of the Study:
- To evaluate the outcomes of revision surgery in patients with persistent shoulder problems post-acromioplasty.
- To identify the causes of failure, including diagnostic and operative errors.
Main Methods:
- Retrospective review of 67 shoulders in 65 patients with >2 years of symptoms post-acromioplasty.
- Comprehensive evaluation including history, physical exam, local anesthesia injection, and diagnostic arthroscopy.
- Analysis of diagnostic and operative errors, and correlation with surgical outcomes.
Main Results:
- Diagnostic errors occurred in 27 shoulders, and operative errors in 28 shoulders.
- Only 12 shoulders had correct diagnosis and operative procedure initially.
- Revision surgery success rate was 75% for non-worker's compensation patients vs. 46% for worker's compensation patients.
Conclusions:
- A high rate of diagnostic and operative errors contributes to persistent shoulder dysfunction after acromioplasty.
- Revision surgery can be effective, but outcomes are significantly influenced by worker's compensation status.