Arthroscopic subacromial decompression versus placebo surgery for subacromial pain syndrome: 10 year follow-up of the FIMPACT randomised, placebo surgery controlled trial 

1. This randomized controlled trial found that arthroscopic subacromial decompression does not provide meaningful long-term benefit for subacromial pain syndrome.

Evidence Rating Level: 1 (Excellent)

Arthroscopic subacromial decompression (ASD) has long been one of the most frequently performed orthopedic procedures for persistent shoulder pain, despite growing evidence suggesting minimal short or medium-term clinical benefit. This study provides the 10-year follow-up of the FIMPACT (Finnish Subacromial Impingement Arthroscopy Trial), a randomized, placebo-controlled trial, designed to determine whether ASD offers any long-term advantage over placebo surgery or structured exercise therapy for patients with subacromial pain syndrome. A total of 210 adults aged 35–65 with over three months of refractory symptoms were enrolled, undergoing either ASD, diagnostic arthroscopy (placebo surgery), or a supervised physiotherapy program. Shoulder pain at rest and on arm activity, assessed using a 100-point visual analogue scale (VAS), were the primary outcomes, with a minimally important difference defined as 15 points. At the 10-year follow-up, all groups demonstrated substantial and sustained symptom improvement from baseline, with most gains occurring by year five and stabilizing thereafter. However, no significant differences were detected between ASD and placebo surgery for either primary outcome (VAS pain at rest: mean difference −1.5; 95% CI: −8.6, 5.6; pain on arm activity: −3.2; 95% CI: −13.0, 6.5). Similarly, ASD showed no meaningful advantage over exercise therapy (pain at rest: −4.0; 95% CI: −11.0, 3.0; pain on activity: −9.4; 95% CI: −19.0, 0.3), with all estimates falling below the clinically relevant threshold. Secondary outcomes, including functional scores, health-related quality of life, satisfaction, and adverse events, likewise demonstrated no significant between-group differences. Sensitivity analyses confirmed the robustness of the findings. Overall, the study indicates that ASD confers no long-term clinical benefit beyond placebo surgery or targeted physiotherapy in managing subacromial pain syndrome over 10 years. These results, consistent across short-, medium-, and long-term follow-ups, underscore the need for de-implementation of ASD in routine care and reinforce exercise-based management as an effective, less invasive alternative.

Click here to read this study in the BMJ

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