TY - JOUR
T1 - Subacromial Decompression in Patients With Shoulder Impingement With an Intact Rotator Cuff
T2 - An Expert Consensus Statement Using the Modified Delphi Technique Comparing North American to European Shoulder Surgeons
AU - Delphi Panel
AU - Hohmann, Erik
AU - Glatt, Vaida
AU - Tetsworth, Kevin
AU - Alentorn-Geli, Eduard
AU - Bak, Klaus
AU - Beitzel, Knut
AU - Bøe, Berte
AU - Calvo, Emilio
AU - Di Giacomo, Giovanni
AU - Favard, Luc
AU - Franceschi, Francesco
AU - Funk, Lennard
AU - Glanzmann, Michael
AU - Imhoff, Andreas
AU - Lädermann, Alexandre
AU - Levy, Ofer
AU - Ludvigsen, Tom
AU - Milano, Giuseppe
AU - Moroder, Philipp
AU - Rosso, Claudio
AU - Siebenlist, Sebastian
AU - Abrams, Jeffrey
AU - Arciero, Robert
AU - Athwal, George
AU - Burks, Robert
AU - Gillespie, Robert
AU - Kibler, Ben
AU - Levine, William
AU - Mazzocca, Augustus
AU - Millett, Peter
AU - Ryu, Richard
AU - Safran, Marc
AU - Sanchez-Sotelo, Joaquin
AU - Savoie, Felix “Buddy”
AU - Sethi, Paul
AU - Shea, Kevin
AU - Verma, Nikhil
AU - Warner, Jon J.P.
AU - Weber, Stephen
AU - Wolf, Brian
N1 - Funding Information:
The authors report the following potential conflicts of interest or sources of funding: K.B. reports personal fees from Arthrex, outside the submitted work. B.B. reports grants and personal fees from Smith & Nephew and personal fees from Ortomedic, outside the submitted work. E.H. reports personal fees Arthroscopy Association of North America, outside the submitted work. J.S. reports grants from Stryker-Wright, other from Exactech, Acumed, Precision OS, PSI, Elsevier, Oxford University Press, and Journal of Shoulder and Elbow Surgery, outside the submitted work. R.A. reports other from Biorez, and grants from Don-Joy and Arthrex, outside the submitted work. G.A. reports other from ConMed Linvatec, outside the submitted work. E.C. reports personal fees from DePuy Mitek, Stryker, and Smith & Nephew, outside the submitted work. D.G.D. and L.F. report personal fees from Wright, outside the submitted work. A.L. reports personal fees from Wright, Medacta, and Arthrex, outside the submitted work. A.M. reports grants and personal fees from Arthrex, outside the submitted work. G.M. reports personal fees and nonfinancial support from Arthrex, grants and nonfinancial support from FGP, grants and nonfinancial support from GreenBone, and personal fees from Stryker, outside the submitted work. P. Moroder reports grants and personal fees from Arthrex, personal fees from DePuy Synthes Mitek Sportsmedicine, outside the submitted work. C.R. reports personal fees from LIMA and Arthrex, outside the submitted work. B.W. reports personal fees from ConMed Linvatec, outside the submitted work. P. Millett reports grants and personal fees from Arthrex, personal fees from Medbridge and Springer Publishing, and other from GameReady, VuMedi, Smith & Nephew, Arthrex, Siemens, and Ossur, outside the submitted work. S.S. reports personal fees from Arthrex, Medartis AG, and KLS Martin, Group, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material .
Funding Information:
The authors report the following potential conflicts of interest or sources of funding: K.B. reports personal fees from Arthrex, outside the submitted work. B.B. reports grants and personal fees from Smith & Nephew and personal fees from Ortomedic, outside the submitted work. E.H. reports personal fees Arthroscopy Association of North America, outside the submitted work. J.S. reports grants from Stryker-Wright, other from Exactech, Acumed, Precision OS, PSI, Elsevier, Oxford University Press, and Journal of Shoulder and Elbow Surgery, outside the submitted work. R.A. reports other from Biorez, and grants from Don-Joy and Arthrex, outside the submitted work. G.A. reports other from ConMed Linvatec, outside the submitted work. E.C. reports personal fees from DePuy Mitek, Stryker, and Smith & Nephew, outside the submitted work. D.G.D. and L.F. report personal fees from Wright, outside the submitted work. A.L. reports personal fees from Wright, Medacta, and Arthrex, outside the submitted work. A.M. reports grants and personal fees from Arthrex, outside the submitted work. G.M. reports personal fees and nonfinancial support from Arthrex, grants and nonfinancial support from FGP, grants and nonfinancial support from GreenBone, and personal fees from Stryker, outside the submitted work. P. Moroder reports grants and personal fees from Arthrex, personal fees from DePuy Synthes Mitek Sportsmedicine, outside the submitted work. C.R. reports personal fees from LIMA and Arthrex, outside the submitted work. B.W. reports personal fees from ConMed Linvatec, outside the submitted work. P. Millett reports grants and personal fees from Arthrex, personal fees from Medbridge and Springer Publishing, and other from GameReady, VuMedi, Smith & Nephew, Arthrex, Siemens, and Ossur, outside the submitted work. S.S. reports personal fees from Arthrex, Medartis AG, and KLS Martin Group, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Publisher Copyright:
© 2021 Arthroscopy Association of North America
PY - 2022/4
Y1 - 2022/4
N2 - Purpose: To perform a Delphi consensus for the treatment of patients with shoulder impingement with intact rotator cuff tendons, comparing North American with European shoulder surgeon preferences. Methods: Nineteen surgeons from North America (North American panel [NAP]) and 18 surgeons from Europe (European panel [EP]) agreed to participate and answered 10 open-ended questions in rounds 1 and 2. The results of the first 2 rounds were used to develop a Likert-style questionnaire for round 3. If agreement at round 3 was ≤60% for an item, the results were carried forward into round 4. For round 4, the panel members outside consensus (>60%, <80%) were contacted and asked to review their response. The level of agreement and consensus was defined as 80%. Results: There was agreement on the following items: impingement is a clinical diagnosis; a combination of clinical tests should be used; other pain generators must be excluded; radiographs must be part of the workup; magnetic resonance imaging is helpful; the first line of treatment should always be physiotherapy; a corticosteroid injection is helpful in reducing symptoms; indication for surgery is failure of nonoperative treatment for a minimum of 6 months. The NAP was likely to routinely prescribe nonsteroidal anti-inflammatory drugs (NAP 89%; EP 35%) and consider steroids for impingement (NAP 89%; EP 65%). Conclusions: Consensus was achieved for 16 of the 71 Likert items: impingement is a clinical diagnosis and a combination of clinical tests should be used. The first line of treatment should always be physiotherapy, and a corticosteroid injection can be helpful in reducing symptoms. The indication for surgery is failure of no-operative treatment for a minimum of 6 months. The panel also agreed that subacromial decompression is a good choice for shoulder impingement if there is evidence of mechanical impingement with pain not responding to nonsurgical measures. Level of Evidence: Level V, expert opinion.
AB - Purpose: To perform a Delphi consensus for the treatment of patients with shoulder impingement with intact rotator cuff tendons, comparing North American with European shoulder surgeon preferences. Methods: Nineteen surgeons from North America (North American panel [NAP]) and 18 surgeons from Europe (European panel [EP]) agreed to participate and answered 10 open-ended questions in rounds 1 and 2. The results of the first 2 rounds were used to develop a Likert-style questionnaire for round 3. If agreement at round 3 was ≤60% for an item, the results were carried forward into round 4. For round 4, the panel members outside consensus (>60%, <80%) were contacted and asked to review their response. The level of agreement and consensus was defined as 80%. Results: There was agreement on the following items: impingement is a clinical diagnosis; a combination of clinical tests should be used; other pain generators must be excluded; radiographs must be part of the workup; magnetic resonance imaging is helpful; the first line of treatment should always be physiotherapy; a corticosteroid injection is helpful in reducing symptoms; indication for surgery is failure of nonoperative treatment for a minimum of 6 months. The NAP was likely to routinely prescribe nonsteroidal anti-inflammatory drugs (NAP 89%; EP 35%) and consider steroids for impingement (NAP 89%; EP 65%). Conclusions: Consensus was achieved for 16 of the 71 Likert items: impingement is a clinical diagnosis and a combination of clinical tests should be used. The first line of treatment should always be physiotherapy, and a corticosteroid injection can be helpful in reducing symptoms. The indication for surgery is failure of no-operative treatment for a minimum of 6 months. The panel also agreed that subacromial decompression is a good choice for shoulder impingement if there is evidence of mechanical impingement with pain not responding to nonsurgical measures. Level of Evidence: Level V, expert opinion.
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U2 - 10.1016/j.arthro.2021.09.031
DO - 10.1016/j.arthro.2021.09.031
M3 - Article
C2 - 34655764
AN - SCOPUS:85123065420
SN - 0749-8063
VL - 38
SP - 1051
EP - 1065
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
IS - 4
ER -