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Should clinicians integrate the findings of The Lancet’s 2018 placebo-controlled subacromial decompression trial into clinical practice?
  1. Alexandre Lädermann1,2,3,
  2. Lionel Neyton4,
  3. Mo Saffarini5,
  4. Philippe Collin6
  1. 1 Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
  2. 2 Faculty of Medicine, University of Geneva, Geneva, Switzerland
  3. 3 Orthopedics and Trauma Service, University Hospitals of Geneva, Geneva, Switzerland
  4. 4 Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
  5. 5 ReSurg SA, Nyon, Switzerland
  6. 6 Department of Orthopaedic Surgery and Sports Medicine, Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
  1. Correspondence to Mo Saffarini; journals{at}

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Earlier this year, Beard et al 1 published the outcomes of a multicentre, placebo-controlled randomised surgical trial in The Lancet, in which they concluded that arthroscopic subacromial decompression has little or no benefits over placebo surgery for the treatment of subacromial shoulder pain. The article instigated heated debates among orthopaedic surgeons and sports physicians, including a critical response in the same journal by Schreurs and van der Pas,2 and a full editorial in the British Journal of Sports Medicine by Littlewood et al. 3 While we agree with many of the points raised, in both the original publication and subsequent correspondence, we are concerned about overinterpretation of these texts to invalidate or discredit subacromial decompression as a primary or adjuvant procedure, based on short-term data and regardless of the aetiologies treated.

Subacromial decompression comprises three main steps, namely ‘removal of bursa and soft tissues within the subacromial space, release of the coracoacromial ligament, and …

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