After the Sham Trials: A Perspective on What Is Left of Subacromial Decompression
DOI:
https://doi.org/10.5281/zenodo.22548316Keywords:
Subacromial decompression, Shoulder impingement, Placebo-controlled surgical trial, Rotator cuff, Sham surgeryAbstract
Arthroscopic subacromial decompression became one of the most commonly performed orthopaedic
procedures in the developed world on the strength of observational case series and a biomechanical
rationale that dated to the early 1970s, without ever being tested against a surgical placebo. When that
test finally came, in two large, independent, placebo-controlled trials published within months of each
other in 2018, decompression performed no better than sham surgery or diagnostic arthroscopy alone.
This perspective sets out what those trials, and the decade of exercise-versus-surgery literature that
preceded them, actually established, what has changed in clinical guidance and practice since, and what
-- if anything -- remains a defensible indication for a procedure that surgeons performed with good
intentions for nearly fifty years before the placebo-controlled evidence caught up with it.
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