Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 12, pp 3856–3863 | Cite as

Radiofrequency microtenotomy: a promising method for treatment of rotator cuff tendinopathy

  • Zeiad Al-Ani
  • Eivind Wergeland Jacobsen
  • Jüri-Toomas Kartus
  • Gunnar Knutsen
  • Khaled MeknasEmail author
SHOULDER

Abstract

Purpose

Subacromial pain syndrome is a common disorder. Arthroscopic subacromial decompression is currently the preferred treatment method. Bipolar radiofrequency microtenotomy has shown promising results in treating tendinosis. In this study, the authors compare the results after arthroscopic acromioplasty with bipolar radiofrequency microtenotomy for patients with subacromial pain syndrome.

Methods

A total of 27 patients, with subacromial pain syndrome, were followed for 2 years. There were 14 patients in the arthroscopic acromioplasty group and 13 patients in the radiofrequency microtenotomy group. Clinical outcome data included pain reported using a visual analog scale, Constant score, and strength. Magnetic resonance imaging of the affected shoulder was performed before and 2 years after intervention for an evaluation of the tendinosis grade.

Results

All patients attended the final follow-up 2 years after intervention. No significant differences were found at baseline between the groups. Pain measured by the visual analog scale revealed a significant reduction in both groups at 12 weeks, 6 months and 2 years compared with baseline. There was no significant difference between the groups in terms of visual analog scale, Constant score, or strength. The magnetic resonance imaging revealed a significant improvement in the tendinosis score in both groups, without any significant difference between the groups.

Conclusion

In this prospective randomized study, the clinical assessments revealed a significant improvement in terms of the visual analog scale, strength, Constant score, and tendinosis score 2 years after intervention with either arthroscopic acromioplasty or radiofrequency microtenotomy in patients with subacromial pain syndrome. However, no significant differences were found between the groups. This study reveals that there are surgical options other than acromioplasty in patients with SAPS.

Level of evidence

II.

Keywords

Subacromial pain syndrome Radiofrequency microtenotomy Acromioplasty 

Notes

Acknowledgements

The authors thank the Clinical Research Department at the University Hospital of North Norway for helping with randomization of the study groups. The authors thank the “Raskere Tilbake” (Quick Return) section at the Orthopedic Department, University Hospital of North Norway for assisting with organizing the study and the recruitment of patients. We are also thankful to Allan Didriksen MD, Hanne Rasmussen MD, and Øyvind Lyngedal RPT at the Orthopedic Department, University Hospital of North Norway for blinded control assessments of the patients.

Funding

No sources of funding to declare.

Compliance with ethical standards

Conflict of interest

Dr. Kartus reports personal fees from Linvatec Sweden, outside the submitted work; and Associate editor Journal of arthroscopy. No Conflict of interest for the other authors.

Ethical approval

The study was approved by the Regional Ethical Committee (no 211/1133).

References

  1. 1.
    Arnal-Burro J, Lopez-Capape D, Igualada-Blazquez C, Ortiz-Espada A, Martin-Garcia A (2016) Surgical treatment of chronic non-insertional Achilles tendinopathy in runners using bipolar radiofrequency. Rev Esp Cir Ortop Traumatol 60(2):125–132PubMedGoogle Scholar
  2. 2.
    Brox JI, Gjengedal E, Uppheim G et al (1999) Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomized, controlled study in 125 patients with a 212-year follow-up. J Shoulder Elb Surg 8(2):102–111CrossRefGoogle Scholar
  3. 3.
    Bryceland JK, Drury C, Tait GR (2015) Current UK practices in the management of subacromial impingement. Shoulder Elb 7(3):164–167CrossRefGoogle Scholar
  4. 4.
    Dakin SG, Martinez FO, Yapp C, Wells G, Oppermann U, Dean BJ, Smith RD, Wheway K, Watkins B, Roche L, Carr AJ (2015) Inflammation activation and resolution in human tendon disease. Sci Transl Med 7(311):311ra173CrossRefGoogle Scholar
  5. 5.
    Dorrestijn O, Stevens M, Winters JC, van der Meer K, Diercks RL (2009) Conservative or surgical treatment for subacromial impingement syndrome? A systematic review. J Shoulder Elb Surg 18(4):652–660CrossRefGoogle Scholar
  6. 6.
    Ellman H (1987) Arthroscopic subacromial decompression: analysis of 1–3-year results. Arthroscopy 3(3):173–181CrossRefGoogle Scholar
  7. 7.
    Escamilla RF, Hooks TR, Wilk KE (2014) Optimal management of shoulder impingement syndrome. Open Access J Sports Med 5:13–24CrossRefGoogle Scholar
  8. 8.
    Factor D, Dale B (2014) Current concepts of rotator cuff tendinopathy. Int J Sports Phys Ther 9(2):274–288PubMedPubMedCentralGoogle Scholar
  9. 9.
    Farfaras S, Sernert N, Rostgard Christensen L, Hallström EK, Kartus JT (2018) Subacromial decompresion yields a better clinical outcome than therapy alone: a prospective randomized study of patients with a minimum 10-year follow-up. Am J Sports Med 46(6):1397–1407CrossRefGoogle Scholar
  10. 10.
    Farfaras S, Ejerhed LE, Hallström EK, Hultenby K, Meknas K, Movin T, Papadogiannakis N, Kartus JT (2018) More histologic and ultrastructural degenerative signs in the subscapularis tendon and the joint capsule in male patients with shoulder impingement. Knee Surg Sports Traumatol Arthrosc 26(1):79–87CrossRefGoogle Scholar
  11. 11.
    Gebremariam L, Hay EM, van der Sande R, Rinkel WD, Koes BW, Huisstede BM (2014) Subacromial impingement syndrome—effectiveness of physiotherapy and manual therapy. Br J Sports Med 48(16):1202–1208CrossRefGoogle Scholar
  12. 12.
    Greenberg DL (2014) Evaluation and treatment of shoulder pain. Med Clin N Am 98(3):487–504CrossRefGoogle Scholar
  13. 13.
    Haahr JP, Ostergaard S, Dalsgaard J et al (2005) Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a 1 year follow up. Ann Rheum Dis 64(5):760–764CrossRefGoogle Scholar
  14. 14.
    Haahr JP, Andersen JH (2006) Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4–8-years' follow-up in a prospective, randomized study. Scand J Rheumatol 35(3):224–228CrossRefGoogle Scholar
  15. 15.
    Henkus HE, de Witte PB, Nelissen RG, Brand R, van Arkel ER (2009) Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: a prospective randomised study. J Bone Jt Surg Br 91(4):504–510CrossRefGoogle Scholar
  16. 16.
    Ketola S, Lehtinen J, Rousi T, Nissinen M, Huhtala H, Arnala I (2015) Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment? Acta Orthop 86(6):641–646CrossRefGoogle Scholar
  17. 17.
    Ketola S, Lehtinen JT, Arnala I (2017) Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy: a final review of a randomised controlled trial at a minimum follow-up of 10 years. Bone Jt J 99-B(6):799–805CrossRefGoogle Scholar
  18. 18.
    Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M (1999) Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med 27(6):393–408CrossRefGoogle Scholar
  19. 19.
    Ben Kibler BW, Sciascia A (2008) What went wrong and what to do about it: pitfalls in the treatment of shoulder impingement. Instr Course Lect 57:103–112 (Presented at the annual meeting of the AAOS, San Francisco March 5–9) PubMedGoogle Scholar
  20. 20.
    Kuhn JE (2009) Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elb Surg 18(1):138–160CrossRefGoogle Scholar
  21. 21.
    Lu Y, Zhang Q, Zhu Y, Jiang C (2013) Is radiofrequency treatment effective for shoulder impingement syndrome? A prospective randomized controlled study. J Shoulder Elb Surg 22(11):1488–1494CrossRefGoogle Scholar
  22. 22.
    Lucas DE, Ekroth SR, Hyer CF (2015) Intermediate-term results of partial plantar fascia release with microtenotomy using bipolar radiofrequency microtenotomy. J Foot Ankle Surg 54(2):179–182CrossRefGoogle Scholar
  23. 23.
    Meknas K, Odden-Miland A, Mercer JB, Castillejo M, Johansen O (2008) Radiofrequency microtenotomy: a promising method for treatment of recalcitrant lateral epicondylitis. Am J Sports Med 36(10):1960–1965CrossRefGoogle Scholar
  24. 24.
    Nazari G, MacDermid JC, Bryant D, Athwal GS (2019) The effectiveness of surgical vs conservative interventions on pain and function in patients with shoulder impingement syndrome. A systematic review and meta-analysis. PLoS ONE 14(5):e0216961CrossRefGoogle Scholar
  25. 25.
    Neer CS 2nd (2005) Anterior acromioplasty for the chronic impingement syndrome in the shoulder. 1972. J Bone Jt Surg Am 87(6):1399CrossRefGoogle Scholar
  26. 26.
    Odenbring S, Wagner P, Atroshi I (2008) Long-term outcomes of arthroscopic acromioplasty for chronic shoulder impingement syndrome: a prospective cohort study with a minimum of 12 years' follow-up. Arthroscopy 24(10):1092–1098CrossRefGoogle Scholar
  27. 27.
    Paavola M, Malmivaara A, Taimela S, Kanto K, Inkinen J, Kalske J, Sinisaari I, Savolainen V, Ranstam J, Jarvinen TLN (2019) In shoulder impingement syndrome, subacromial decompression did not differ from diagnostic arthroscopy for shoulder pain at 24 months. J Bone Jt Surg Am 101(4):369CrossRefGoogle Scholar
  28. 28.
    Rothenberg A, Gasbarro G, Chlebeck J, Lin A (2017) The coracoacromial ligament: anatomy, function, and clinical significance. Orthop J Sports Med 5(4):2325967117703398CrossRefGoogle Scholar
  29. 29.
    Saltychev M, Aarimaa V, Virolainen P, Laimi K (2015) Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis. Disabil Rehabil 37(1):1–8CrossRefGoogle Scholar
  30. 30.
    Santana Pineda MM, Vanlinthout LE, Moreno Martin A, van Zundert J, Rodriguez Huertas F, Novalbos Ruiz JP (2017) Analgesic effect and functional improvement caused by radiofrequency treatment of genicular nerves in patients with advanced osteoarthritis of the knee until 1 year following treatment. Reg Anesth Pain Med 42(1):62–68CrossRefGoogle Scholar
  31. 31.
    Tasto JP, Cummings J, Medlock V, Harwood F, Hardesty R, Amiel D (2003) The tendon treatment center: new horizons in the treatment of tendinosis. Arthroscopy 19(Suppl 1):213–223CrossRefGoogle Scholar
  32. 32.
    Taverna E, Battistella F, Sansone V, Perfetti C, Tasto JP (2007) Radiofrequency-based plasma microtenotomy compared with arthroscopic subacromial decompression yields equivalent outcomes for rotator cuff tendinosis. Arthroscopy 23(10):1042–1051CrossRefGoogle Scholar
  33. 33.
    Vandvik PO, Lähdeoja T, Ardern C, Buchbinder R, Moro J, Brox JI, Burgers J, Hao Q, Karjalainen T et al (2019) Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline. BMJ 6(364):l294CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of RadiologyUniversity Hospital North NorwayTromsöNorway
  2. 2.Department of OrthopedicsUniversity Hospital North NorwayTromsöNorway
  3. 3.Orthopedics Research Group, Institute of Clinical MedicineThe Arctic University of NorwayTromsöNorway
  4. 4.Department of OrthopedicsNU-Hospital Group, University of GothenburgTrollhättanSweden

Personalised recommendations