Operative release of the impingement syndrome. Indication, technique, results

We examined the long-term results of two different methods of shoulder decompression (Neer acromioplasty and resection of the coracoacromial ligament) after an average observation period of 8 years. Clinical and radiological features were evaluated in 48 patients with 50 treated shoulders, as was the subjective result of the treatment in 58 patients with 61 operated joints. Pain was substantially eased in 93% (acromioplasty) and 100% (ligamentary resection), mobility improved in 76% and 83%, respectively. A favourable result was achieved in 86% of the acromioplasty cases and in 75% of the ligament resection cases. In one-third of the shoulders, an increasing degeneration of joint structures could be demonstrated radiologically; the degree depended on the severity of the initial rotator cuff injury, not on the method of shoulder decompression. The differences between both surgical methods examined were not statistically significant, but acromioplasty provides a superior extension of the subacromial space and protection for the reconstructed rotator cuff tendons. Our results compare favourably with other published studies. The methods described are suitable for the treatment of subacromial impingement.