***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To investigate the efficacy of a programme of manual therapy and exercise treatment compared with placebo treatment delivered by physiotherapists for people with chronic rotator cuff disease . Design R and omised , participant and single assessor blinded , placebo controlled trial . Setting Metropolitan region of Melbourne , Victoria , Australia . Participants 120 participants with chronic ( > 3 months ) rotator cuff disease recruited through medical practitioners and from the community . Interventions The active treatment comprised a manual therapy and home exercise programme ; the placebo treatment comprised inactive ultrasound therapy and application of an inert gel . Participants in both groups received 10 sessions of individual st and ardised treatment over 10 weeks . For the following 12 weeks , the active group continued the home exercise programme and the placebo group received no treatment . Main outcome measures The primary outcomes were pain and function measured by the shoulder pain and disability index , average pain on movement measured on an 11 point numerical rating scale , and participants ’ perceived global rating of overall change . Results 112 ( 93 % ) participants completed the 22 week trial . At 11 weeks no difference was found between groups for change in shoulder pain and disability index ( 3.6 , 95 % confidence interval −2.1 to 9.4 ) or change in pain ( 0.7 , −0.1 to 1.5 ) ; both groups showed significant improvements . More participants in the active group reported a successful outcome ( defined as “ much better ” ) , although the difference was not statistically significant : 42 % ( 24/57 ) of active participants and 30 % ( 18/61 ) of placebo participants ( relative risk 1.43 , 0.87 to 2.34 ) . The active group showed a significantly greater improvement in shoulder pain and disability index than did the placebo group at 22 weeks ( between group difference 7.1 , 0.3 to 13.9 ) , although no significant difference existed between groups for change in pain ( 0.9 , −0.03 to 1.7 ) or for the percentage of participants reporting a successful treatment outcome ( relative risk 1.39 , 0.94 to 2.03 ) . Several secondary outcomes favoured the active group , including shoulder pain and disability index function score , muscle strength , interference with activity , and quality of life . Conclusion A st and ardised programme of manual therapy and home exercise did not confer additional immediate benefits for pain and function compared with a realistic placebo treatment that controlled for therapists ’ contact in middle aged to older adults with chronic rotator cuff disease . However , greater improvements were apparent at follow-up , particularly in shoulder function and strength , suggesting that benefits with active treatment take longer to manifest . Trial registration Clinical trials NCT00415441 BACKGROUND Controversy exists regarding the optimal technique for arthroscopic rotator cuff repair . The purpose of this multicenter , r and omized , double-blind controlled study was to compare the functional outcomes and healing rates after use of single-row and double-row suture techniques for repair of the rotator cuff . METHODS Ninety patients undergoing arthroscopic rotator cuff repair  were r and omized to receive either a single-row or a double-row repair . The primary objective was to compare the Western Ontario rotator cuff index ( WORC ) score at twenty-four months . Secondary objectives included comparison of the constant and american shoulder and elbow surgeons ( ASES ) scores and strength between groups . Anatomical outcomes were assessed with magnetic resonance imaging ( MRI ) or ultrasonography to determine the postoperative healing rates . RESULTS Baseline demographic data including age ( p = 0.29 ) , sex ( p = 0.68 ) , affected side ( p = 0.39 ) , and rotator cuff tear size ( p = 0.28 ) did not differ between groups . The WORC score did not differ significantly between groups at any time point ( p = 0.48 at baseline , p = 0.089 at three months , p = 0.52 at six months , p = 0.83 at twelve months , and p = 0.60 at twenty-four months ) . The WORC score at each postoperative time point was significantly better than the baseline value . The Constant score , ASES score , and strength did not differ significantly between groups at any time point . Logistic regression analysis demonstrated that a smaller initial tear size and double-row fixation were associated with higher healing rates . CONCLUSIONS No significant differences in functional or quality -of-life outcomes were identified between single-row and double-row fixation techniques . A smaller initial tear size and a double-row fixation technique were associated with higher healing rates as assessed with ultrasonography or MRI . LEVEL OF EVIDENCE Therapeutic level I. See Instructions for Authors for a complete description of levels of evidence Purpose The purpose of this study was to compare arthroscopic rotator cuff repair with single-row and double-row techniques because research has demonstrated the superiority of double-row repair from a biological and mechanical point of view but there is no evidence of clinical superiority . Methods A total of 160 patients with a full-thickness rotator cuff tear underwent arthroscopic repair with suture anchors .  They were r and omised into two groups of 80 patients according to the repair technique : single-row ( group 1 ) and double-row ( group 2 ) . Results were evaluated by use of the University of California , Los Angeles ( UCLA ) , American Shoulder and Elbow Surgeons ( ASES ) and Constant question naires , the Shoulder Strength Index ( SSI ) and range of motion . Follow-up time was two years . Magnetic resonance imaging ( MRI ) studies were performed on each shoulder preoperatively and two years after repair . Results One hundred per cent of the patients were followed up . All measurements showed significant improvement compared with the preoperative status . The UCLA score showed significant improvement in group 2 . In over 30-mm tears UCLA and ASES showed significant differences . SSI showed significant improvement in group 2 . Range of motion showed significant improvements in flexion and abduction in group 2 . In under 30-mm tears group 2 showed also significant improvement in internal and external rotation . In MRI studies there were no significant differences . Conclusions At two years follow-up the double-row repair technique showed a significant difference in clinical outcome compared with single-row repair and this was even more significative in over 30-mm tears . No MRI differences were observed PURPOSE This study aim ed to determine whether radiofrequency (RF)-based plasma microtenotomy ( microdebridement ) was effective for treating chronic supraspinatus tendinosis . METHODS The institutional ethics committee approved the study design , and all patients signed informed consent forms . Patients ( age range , 30 to 70 years ) were considered for enrollment if 6 months of active conservative treatment had failed and they had Neer stage II impingement syndrome , positive radiographic evidence of type II acromion , and magnetic resonance imaging or ultrasound evidence of supraspinatus tendinosis . Patients ( N = 60 ) were r and omly assigned to undergo arthroscopic subacromial decompression or RF-based plasma microtenotomy .  For microtenotomy , a bipolar RF-based probe ( TOPAZ ; ArthroCare , Austin , TX ) was used to perform microdebridement in the supraspinatus tendon ; patients did not undergo acromioplasty . Outcomes evaluation consisted of self-reported pain via a visual analog scale , as well as functional assessment ( American Shoulder and Elbow Surgeons [ ASES ] survey , Constant score , and University of California , Los Angeles [ UCLA ] question naire ) . Statistical analyses were performed by use of factorial dependent- measures analysis of variance tests . RESULTS Age and baseline scores on the visual analog scale ( mean + /- SD ) were 52.0 + /- 6.7 and 53.2 + /- 6.6 years and 8.4 + /- 0.9 and 8.2 + /- 0.8 points in the microtenotomy and arthroscopic subacromial decompression groups , respectively . A significant reduction in pain ( P < .001 ) and improved function ( P < .001 for all measures ) were observed in both groups postoperatively . Both treatment groups had almost identical longitudinal recovery profiles for pain relief ( P = .416 ) and restoration of function ( P = .964 for ASES score , P = .978 for Constant score , and P = .794 for UCLA score ) . At 1 year , the median pain score was 1.0 , and all patients had ASES , Constant , and UCLA scores of greater than 90 , greater than 80 , and greater than 30 , respectively . CONCLUSIONS Both procedures were associated with significant improvement postoperatively , but the RF-based plasma microtenotomy procedure draws into question the need for a more extensive procedure such as subacromial decompression in this patient population . LEVEL OF EVIDENCE Level I , therapeutic r and omized controlled study OBJECTIVES To compare the effect of grade d physiotherapeutic training of the rotator cuff versus arthroscopic subacromial decompression in patients with subacromial impingement . METHODS R and omised controlled trial with 12 months ' follow up in a hospital setting . Ninety consecutive patients aged 18 to 55 years were enrolled . Symptom duration was between six months and three years . All fulfilled a set of diagnostic criteria for rotator cuff disease , including a positive impingement sign . Patients were r and omised either to arthroscopic subacromial decompression , or to physiotherapy with exercises aim ing at strengthening the stabilisers and decompressors of the shoulder . Outcome was shoulder function as measured by the Constant score and a pain and dysfunction score . " Intention to treat " analysis was used , with comparison of means and control of confounding variables by general equation estimation analysis . RESULTS Of 90 patients enrolled , 84 completed follow up ( 41 in the surgery group , 43 in the training group ) . The mean Constant score at baseline was 34.8 in the training group and 33.7 in the surgery group . After 12 months the mean scores improved to 57.0 and 52.7 , respectively , the difference being non-significant . No group differences in mean pain and dysfunction score improvement were found . CONCLUSIONS Surgical treatment of rotator cuff syndrome with subacromial impingement was not superior to physiotherapy with training . Further studies are needed to qualify treatment choice decisions , and it is recommended that sample s are stratified according to disability level In a r and omized prospect i ve study , we selected 15 patients for arthroscopic subacromial decompression ( ASD ) and 19 patients for open subacromial decompression ( OSD ) . All had impingement syndrome ( Neer grade II ) , and had been unsuccessfully treated without surgery for more than 6 months . The UCLA Shoulder Rating Scale , Visual Analogue Scales for pain and satisfaction , isokinetic dynamometer recordings and physical testing were assessed preoperatively and at 1 ( except isokinetic testing ) , 3 , 6 , and 12 months , and , finally , 8 years after surgery . We found essentially no differences in the clinical tests between the groups during this period . The use of ASD or OSD seems to be a matter of cosmesis and personal preference This prospect i ve study was design ed to measure the costs and benefits of using a laser rather than electrocautery for soft tissue resection during arthroscopic shoulder decompression . Forty-nine shoulders with refractory Neer stage II impingement ( persistent fibrosis and tendinitis ) were divided into 2 groups . The composition of the 2 groups was similar with regard to sex , worker 's compensation status , dominant arm involvement , duration of symptoms , and length of conservative treatment . In one group , electrocautery was used to ablate the bursa and periosteum , release the coracoacromial ligament , and maintain hemostasis . In the other group , a laser was used in place of electrocautery . Patients had been evaluated preoperatively with 2 functional scoring systems . The patients were reexamined at 1 week and at 1 , 2 , 3 , 6 , and 12 months after surgery . There were no differences between the groups with regard to functional outcome or satisfaction . There was also no difference in terms of estimated blood loss or operative time . However , there was a statistically significant difference in total hospital charges between groups , with the laser group having a 23 % higher hospital bill . On the basis of these results , it is concluded that there was no medical benefit to laser-assisted arthroscopic subacromial decompression but there was an increased monetary cost Objectives : To compare the prognosis of subacromial impingement ( SAI ) stage II treated conservatively or with subacromial decompression . Methods : A follow‐up study after 4–8 years in a r and omized controlled trial ( RCT ) with 90 adult cases with SAI treated in a Danish hospital from 1996 to 2000 with grade d physiotherapy and exercises or arthroscopic subacromial decompression .  Outcomes were proportion of time per year with income transfers ( indexed 0–1 ) , including total transfers ( marginalization ) , sick leave and disability pension obtained from the registry at the Ministry of Work . Self‐reported function , working capability , employment status and global improvement were obtained by question naire in September 2004 . The main outcomes are given as differences in development from baseline . Results : Seventy‐nine ( 88 % ) responded to the question naire and registry data were obtained from 81 . After 1 year the marginalization index increased by 0.45 [ 95 % confidence interval ( CI ) 0.35–0.56 ] for surgery and 0.25 ( 0.16–0.34 ) for physiotherapy . Cases undergoing surgery also tended to have more sick payments during the first year , but the difference was not significant . Four years after inclusion , changes in indices did not differ between treatment groups . Self‐reported outcomes after 4–8 years did not differ between treatment groups . Conclusion : The results of surgical decompression were equal to those of conservative treatment , and the surg 
    Output:
    
Based on low- to moderate- quality evidence , acromioplasty , be it open or arthroscopic , is no more effective than exercises for the treatment of RC tendinopathy .
Low- grade evidence also suggests that arthroscopic acromioplasty may yield better results in the short-term for shoulder range of motion in flexion compared to open acromioplasty , but long-term results are comparable between the two types of surgery .