[Arthroscopic subacromial decompression--personal experience and results].

PURPOSE OF THE STUDY: The aim of the study was to evaluate the outcomes of a comparatively new surgical technique--the arthroscopic subacromial decompression, justify its use and give reasons for refraining from open acromioplasty after Neer. The evaluated clinical sample comprised a relatively large group of patients, the biggest one presented so far in the Czech literature. The authors point out the benefits of this procedure and on the basis of the outcomes recommend its further use.

MATERIAL: In the period of January 1999 through November 2001 we performed arthroscopic subacromial decompression for primary or post-injury impingement syndrome in 63 shoulders in 61 patients (average age 43.6 years). In the time interval of 6-24 months we followed up all the patients. The group did not include the patients with stabilization or suture of the rotator cuff performed in one step.

METHODS: The surgery was performed in the "beach-chair" position of the patient with the arthroscope introduced through the "soft-spot". First the glenohumeral joint was examined and subsequently the shaver was applied in the subacromial region from the lateral port. In most of the patients we performed apart from soft-tissue subacromial decompression also a partial resection of the acromion. Evaluation of the outcomes was based on the modification of the Constant's functional score and questionnaires filled in by patients.

RESULTS: In the time interval of 6-24 months we followed up all the patients. In 42 patients (66.7%) the result was excellent (80-100 points after Constant), in 18 patients (28.6%) the result was good (65-79 points) and in 2 patients (3.2%) a fair result (51-64 points) was achieved. Poor result (45 points) occurred only in one patient. Total improvement in the Constant score amounted on average to 27 points.

DISCUSSION: The group of patients was first of all compared with our previously evaluated group of 32 patients after an open acromioplasty after Neer where we achieved only 68% of excellent and good results. Better results were achieved with a more aggressive approach and a larger resection of the acromion. Our group was the biggest group so far evaluated in the Czech literature. In comparison with other authors (Podskubka, Procházka) we achieved better results. However, these authors used UCLA score for evaluation. In comparison with foreign authors (Rockwood, Copeland, Ellman, Orljanski, Delej, Weissinger) our results were similar or better. Our experience is similar to that of the mentioned authors.

CONCLUSIONS: Total improvement in the Constant's score by 27 points on average and 95% of excellent and good results justify further use of this considerate method (cosmetic effect, the possibility of immediate physiotherapy, less pain, elimination of the detachment of the deltoid muscle) with a reasonable indication and sufficient scope of the resection of the acromion.