Thank you for the opportunity to present our work. We have no disclosures related to this study. So shoulder pain due to rotator cuff pathology is very common, affecting about 22% of the population. The etiology of rotator cuff tendinopathy remains unclear, and both intrinsic and extrinsic theories have been proposed. Intrinsic theory suggests that aging and intrinsic pathological tendon degeneration due to eccentric overload play a role in rotator cuff disease. So from this perspective, subacromial decompression will not address these processes, and so there's no merit to performing the acromioplasty. In contrast, extrinsic theory suggests that factors causing mechanical compression on the bursal side of rotator cuff tendons leads to their dysfunction and eventual tearing. So subacromial decompression described as briskeptomy, coracoacromial release, and acromioplasty could then eliminate this compression. Based on these theories, the role of acromioplasty at the time of rotator cuff surgery is controversial, with some studies showing good outcomes after performing acromioplasty, while others failed to show any additional benefit. Our research group conducted a randomized trial in 2011 that found no significant difference in functional outcomes between patients that underwent rotator cuff repair with or without acromioplasty. But at that time, to two years post-op, a higher rate of revision surgery was reported among those that did not undergo acromioplasty, four versus one. So the aim of this current study was to reevaluate these patients to determine the long-term efficacy of performing acromioplasty in cases of full thickness rotator cuff tears. So this is a secondary study based on previous multi-centered double-blind trial with patients allocated to arthroscopic rotator cuff repair with or without acromioplasty. The recruitment from the original trial was conducted between 2003 and 2009, and the current study was conducted between 2015 and 2021. The study criteria for the original study are listed here. An attempt was made to invite all patients from the original study to return for follow-up visit. If a patient was unable to return, they were asked to complete the Western Ontario Rotator Cuff Index by mail. A chart review was also conducted along with the patients being asked if they had any surgeries after their primary study-related rotator cuff repair. In the original trial, we randomized 45 to no acromioplasty and 41 to acromioplasty. And due to patients declining, passing away, or having no current contact info, we were left with 31 in no acromioplasty group and 25 in the acromioplasty group. Here are the demographics of the current groups with time from surgery being comparable at 11 years, age at time of surgery and age at time of our long-term follow-up being similar, and the distributions of sex and acromion type being similar. This chart conveys work scores with blue representing no acromioplasty and orange representing acromioplasty. And as you can see, there's no differences between groups at any time point. This chart demonstrates range of motion at the current study time point with no differences between groups. So again, the most interesting finding of this study is revision rate. Seven patients from the no acromioplasty group had revision surgery, while only one patient from the acromioplasty group underwent any re-operation, which is a significant difference. Of note, all the patients that underwent re-operation had type 2 or 3 acromions. So in conclusion, patients that underwent cuff repair with or without acromioplasty improved from pre-op to both 24 months and 11 years follow-up, and there were no differences in work or range of motion between groups at any time point. However, the key finding is that those who did not undergo acromioplasty had more re-operations than those with acromioplasty. Thank you.

rotator cuff pathology

acromioplasty

rotator cuff tendinopathy

intrinsic theory

extrinsic theory