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Anam E, Zahran S, Roy A, Daneshvar P, Bicknell RT, Janssen I. Surgical approaches of shoulder calcific tendonitis: a systematic review and meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:353-358. [PMID: 39157234 PMCID: PMC11329037 DOI: 10.1016/j.xrrt.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Background Calcific tendonitis is a painful shoulder disorder characterized by calcium deposits (CDs) in the rotator cuff tendon. This systematic review and meta-analysis examined the most efficient surgical procedure for calcific tendonitis. This includes the comparison between the three main surgical techniques: CD removal, CD removal with subacromial decompression (SAD) and CD removal with tendon repair with respect to functional outcomes and pain control scores. Methods Four electronic databases (MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials) were searched in February 2023. Studies were eligible for inclusion if they were peer-reviewed, and participants were patients diagnosed with calcific tendonitis of one or more rotator cuff tendon based on diagnostic imaging who underwent shoulder calcific tendonitis surgery. Other shoulder pathology diagnoses were excluded. Meta-analyses were conducted for results that were sufficiently homogeneous in terms of statistical, clinical, and methodological characteristics. Subgroup analyses were performed to determine if effect sizes differed based on the patient's position during the surgery, physiotherapy, and follow-up time. Results All surgical interventions resulted in significant improvements in shoulder function and pain control. There were no significant differences between CD removal vs. CD removal with SAD or CD removal vs. CD removal with tendon repair. However, there was a trend in favor of CD removal alone or CD removal with SAD approaches, as they provided better outcome scores than CD removal with tendon repair in terms of shoulder function and pain control. Conclusions All surgical interventions provide substantial improvement in shoulder functions and pain control scores with no significant difference between these surgical techniques.
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Affiliation(s)
- Emad Anam
- Orthopedic Surgery Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Samah Zahran
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON, Canada
| | - Angelique Roy
- Health Sciences Library, Queen’s University, Kingston, ON, Canada
| | - Parham Daneshvar
- Division of Orthopedic Surgery, Department of Surgery, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Ryan T. Bicknell
- Division of Orthopedic Surgery, Department of Surgery, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
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González-Martín D, Garrido-Miguel M, de Cabo G, Lomo-Garrote JM, Leyes M, Hernández-Castillejo LE. Rotator cuff debridement compared with rotator cuff repair in arthroscopic treatment of calcifying tendinitis of the shoulder: A systematic review and meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023:S1888-4415(23)00187-X. [PMID: 37573942 DOI: 10.1016/j.recot.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Although conservative treatment of calcific tendinopathy has a high success rate, arthroscopic excision of the calcific deposit is occasionally necessary. Controversy exists as to whether the remaining rotator cuff defect can be left in situ or should be repaired to achieve better functional outcomes. This study aimed to compare the results of debridement versus debridement combined with suturing in arthroscopic surgery for calcific tendinopathy. METHODOLOGY MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched from inception to February 2023 for articles on arthroscopic treatment of calcific tendinopathy. Functional outcomes (VAS, ASES, UCLA, and Constant) and the number of complications were analyzed. The effect size was calculated using Cohen's d-index. RESULTS Twenty-one studies were included, including a total of 1172 patients aged between 44.7 and 55 years. The mean follow-up time was 24.7 months. The combined ES estimates for the total score of the VAS, ASES, UCLA, and Constant scales were very strong (>1.0) for both debridement and combined debridement with suture. The ES estimates for the number of total complications were 1.75 (95% CI: 0.08-3.43, I2 = 0%) for debridement and 9.07 (95% CI: -0.03-18.17, I2 = 50.4%) for combined debridement with suture. CONCLUSIONS Both arthroscopic procedures improve the total score significantly on the EVA, ASES, UCLA, and Constant scales. However, a higher proportion of complications was observed in the group that performed suturing. In this regard, we must consider whether it is really necessary to repair all partial tears after the calcified deposits removal.
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Affiliation(s)
- D González-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Origen, Grupo Recoletas, Valladolid, España; Universidad Europea Miguel de Cervantes, Valladolid, España.
| | - M Garrido-Miguel
- Instituto de Investigación Sanitaria de Castilla-La Mancha, Universidad de Castilla La Mancha, Cuenca, España; Facultad de Enfermería, Universidad de Castilla La Mancha, Albacete, España
| | - G de Cabo
- Servicio de Cirugía Ortopédica y Traumatología, Olympia, Quirón Salud, Madrid, España
| | - J M Lomo-Garrote
- Servicio de Cirugía Ortopédica y Traumatología, Origen, Grupo Recoletas, Valladolid, España
| | - M Leyes
- Servicio de Cirugía Ortopédica y Traumatología, Olympia, Quirón Salud, Madrid, España
| | - L E Hernández-Castillejo
- Instituto de Investigación Sanitaria de Castilla-La Mancha, Universidad de Castilla La Mancha, Cuenca, España
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Pang L, Li T, Li Y, Cao Y, Li J, Zhu J, Tang X. Combined arthroscopic rotator cuff repair leads to better clinical outcomes than isolated removal of calcific deposits for shoulder calcific tendinitis: A 2- to 5-year follow-up study. Front Surg 2022; 9:912779. [PMID: 36061068 PMCID: PMC9428341 DOI: 10.3389/fsurg.2022.912779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The optimal treatment procedure for shoulder calcific tendinitis (CT) remains controversial. This study aimed to assess the efficacy of arthroscopic treatment for CT, and to compare the clinical outcomes following combined rotator cuff repair and isolated removal of calcific deposits. Methods This retrospective cohort study included 46 patients (47 shoulders) with confirmed shoulder CT, and the diameter of the calcific deposit was over 1 cm. All patients suffered from CT for a mean period of 17.82 months and had a poor response to conservative treatment. With 12 males and 34 females included, the mean age was 53.94 years. After failed conservative treatment, 23 shoulders underwent combined rotator cuff repair (repair group), and 24 shoulders underwent isolated removal of calcific deposits (debridement group). The clinical outcomes were evaluated at baseline, 3, 6, and 12 months after the surgery and annually thereafter. The efficacy measures included the visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score and radiographic outcomes. Results Remarkable improvement in clinical outcomes at the final follow-up (2- to 5-year) compared with those at baseline were observed (p < 0.0001 for all outcomes). Compared with isolated removal of calcific deposits, combined rotator cuff repair led to worse postoperative 3- and 6-month VAS (p = 0.004 and p = 0.026, respectively), and 3-month ASES scores (p = 0.012). However, better VAS (p = 0.035 and p = 0.007, respectively) and ASES (p = 0.034 and p = 0.020, respectively) scores at 24-month and final follow-up were found in the repair group. All these differences reached the minimal clinical important difference (MCID). MRI scans at the final follow-up showed significantly better outcomes in patients with rotator cuff repair (p = 0.021). Conclusions Arthroscopic removal of calcific deposits is safe and effective for treating CT. Compared with isolated debridement, combined rotator cuff repair led to worse short-term (<12 months) but better medium- (12–48 months) to long-term (≥48 months) improvements in pain, function and integrity of tendons.
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Affiliation(s)
- Long Pang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yinghao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- West China Medical School, Sichuan University, Chengdu, China
| | - Yuanyinuo Cao
- West China Medical School, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Correspondence: Jing Zhu Xin Tang
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Correspondence: Jing Zhu Xin Tang
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Lorbach O, Haupert A, Berger C, Brockmeyer M. Clinical and Structural Results of Rotator Cuff Repair Compared With Rotator Cuff Debridement in Arthroscopic Treatment of Calcifying Tendinitis of the Shoulder. Am J Sports Med 2021; 49:3196-3201. [PMID: 34528841 DOI: 10.1177/03635465211037690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic treatment of calcifying tendinitis of the shoulder reveals good to excellent results. However, whether the tendon needs to be repaired after removal of the calcific deposit or simply debrided remains unclear. PURPOSE To evaluate the structural and clinical results after arthroscopic calcific deposit removal with additional rotator cuff repair or rotator cuff debridement. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 44 patients (46 shoulders) were enrolled in this retrospective cohort study with a mean follow-up of 58.4 months. Patients underwent arthroscopic removal of a calcific deposit and bursectomy after failed nonoperative treatment. A total of 22 patients received additional rotator cuff repair irrespective of the degree of debridement (the repair group), whereas 22 patients received a simple rotator cuff debridement without additional repair (the debridement group). Groups were comparable in sex, age, and size and consistency of the deposits according to the Gärtner and Bosworth classifications. Clinical evaluation was performed by the Constant score, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, and numerical rating scales for pain, function, and satisfaction. In 29 patients (14 in the debridement group and 15 in the repair group), additional magnetic resonance imaging at follow-up was performed to evaluate the structural results using the Sugaya classification. RESULTS All patients were satisfied with the results of surgery; 100% of the repair group and 95.7% of the debridement group reported they would undergo the surgical procedure again. Comparison of the clinical results showed significantly better results in the repair group versus the debridement group for the Constant score (86.2 vs 80.6, respectively; P = .04), the ASES score (98.3 vs 88.9; P = .004), the Simple Shoulder Test (11.6 vs 10; P = .005), and the numerical rating scales for pain (0.1 vs 0.8; P = .007), function (9.6 vs 8.8; P = .008), and satisfaction (9.8 vs 9.1; P = .036). Comparison of the postoperative tendon integrity showed 80% Sugaya grade I in the rotator cuff repair group and 64% Sugaya grade II in the debridement group, with a statistically significant difference in favor of the repair group (P = .004). Postoperative clinical evaluation revealed no positive O'Brien tests in the repair group, whereas approximately one-third of the debridement group showed a positive O'Brien test during examination. CONCLUSION Arthroscopic removal of calcific deposits with rotator cuff debridement or cuff repair showed good to excellent clinical and structural midterm results. However, patients who underwent additional repair of the tendon defect had significantly better clinical results as well as better structural results in terms of tendon integrity.
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Affiliation(s)
- Olaf Lorbach
- Department of Shoulder Surgery and Sports Traumatology, Schoen-Clinic Lorsch, Lorsch, Germany.,Department of Orthopaedic Surgery, Saarland University, Homburg (Saar), Germany
| | - Alexander Haupert
- Department of Orthopaedic Surgery, Saarland University, Homburg (Saar), Germany
| | - Catharina Berger
- Department of Orthopaedic Surgery, Saarland University, Homburg (Saar), Germany
| | - Matthias Brockmeyer
- Department of Orthopaedic Surgery, Saarland University, Homburg (Saar), Germany
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Surace SJ, Deitch J, Johnston RV, Buchbinder R. Shock wave therapy for rotator cuff disease with or without calcification. Cochrane Database Syst Rev 2020; 3:CD008962. [PMID: 32128761 PMCID: PMC7059880 DOI: 10.1002/14651858.cd008962.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Shock wave therapy has seen widespread use since the 1990s to treat various musculoskeletal disorders including rotator cuff disease, but evidence of its efficacy remains equivocal. OBJECTIVES To determine the benefits and harms of shock wave therapy for rotator cuff disease, with or without calcification, and to establish its usefulness in the context of other available treatment options. SEARCH METHODS We searched Ovid MEDLINE, Ovid Embase, CENTRAL, ClinicalTrials.gov and the WHO ICTRP up to November 2019, with no restrictions on language. We reviewed the reference lists of retrieved trials to identify potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that used quasi-randomised methods to allocate participants, investigating participants with rotator cuff disease with or without calcific deposits. We included trials of comparisons of extracorporeal or radial shock wave therapy versus any other intervention. Major outcomes were pain relief greater than 30%, mean pain score, function, patient-reported global assessment of treatment success, quality of life, number of participants experiencing adverse events and number of withdrawals due to adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data and assessed the certainty of evidence using GRADE. The primary comparison was shock wave therapy compared to placebo. MAIN RESULTS Thirty-two trials (2281 participants) met our inclusion criteria. Most trials (25) included participants with rotator cuff disease and calcific deposits, five trials included participants with rotator cuff disease and no calcific deposits, and two trials included a mixed population of participants with and without calcific deposits. Twelve trials compared shock wave therapy to placebo, 11 trials compared high-dose shock wave therapy (0.2 mJ/mm² to 0.4 mJ/mm² and above) to low-dose shock wave therapy. Single trials compared shock wave therapy to ultrasound-guided glucocorticoid needling, ultrasound-guided hyaluronic acid injection, transcutaneous electric nerve stimulation (TENS), no treatment or exercise; dual session shock wave therapy to single session therapy; and different delivery methods of shock wave therapy. Our main comparison was shock wave therapy versus placebo and results are reported for the 3 month follow up. All trials were susceptible to bias; including selection (74%), performance (62%), detection (62%), and selective reporting (45%) biases. No trial measured participant-reported pain relief of 30%. However, in one trial (74 participants), at 3 months follow up, 14/34 participants reported pain relief of 50% or greater with shock wave therapy compared with 15/40 with placebo (risk ratio (RR) 1.10, 95% confidence interval (CI) 0.62 to 1.94); low-quality evidence (downgraded for bias and imprecision). Mean pain (0 to 10 scale, higher scores indicate more pain) was 3.02 points in the placebo group and 0.78 points better (0.17 better to 1.4 better; clinically important change was 1.5 points) with shock wave therapy (9 trials, 608 participants), moderate-quality evidence (downgraded for bias). Mean function (scale 0 to 100, higher scores indicate better function) was 66 points with placebo and 7.9 points better (1.6 better to 14 better, clinically important difference 10 points) with shock wave therapy (9 trials, 612 participants), moderate-quality evidence (downgraded for bias). Participant-reported success was reported by 58/150 people in shock wave therapy group compared with 35/137 people in placebo group (RR 1.59, 95% CI 0.87 to 2.91; 6 trials, 287 participants), low-quality evidence (downgraded for bias and imprecision). None of the trials measured quality of life. Withdrawal rate or adverse event rates may not differ between extracorporeal shock wave therapy and placebo, but we are uncertain due to the small number of events. There were 11/34 withdrawals in the extracorporeal shock wave therapy group compared with 13/40 withdrawals in the placebo group (RR 0.75, 95% CI 0.43 to 1.31; 7 trials, 581 participants) low-quality evidence (downgraded for bias and imprecision); and 41/156 adverse events with extracorporeal shock wave therapy compared with 10/139 adverse events in the placebo group (RR 3.61, 95% CI 2.00 to 6.52; 5 trials, 295 participants) low-quality evidence (downgraded for bias and imprecision). Subgroup analyses indicated that there were no between-group differences in pain and function outcomes in participants who did or did not have calcific deposits in the rotator cuff. AUTHORS' CONCLUSIONS Based upon the currently available low- to moderate-certainty evidence, there were very few clinically important benefits of shock wave therapy, and uncertainty regarding its safety. Wide clinical diversity and varying treatment protocols means that we do not know whether or not some trials tested subtherapeutic doses, possibly underestimating any potential benefits. Further trials of extracorporeal shock wave therapy for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review. A standard dose and treatment protocol should be decided upon before further research is conducted. Development of a core set of outcomes for trials of rotator cuff disease and other shoulder disorders would also facilitate our ability to synthesise the evidence.
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Affiliation(s)
- Stephen J Surace
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
| | - Jessica Deitch
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
| | - Renea V Johnston
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
| | - Rachelle Buchbinder
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
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Long-Term Course of Shoulders After Ultrasound Therapy for Calcific Tendinitis. Am J Phys Med Rehabil 2018; 97:651-658. [DOI: 10.1097/phm.0000000000000939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Current knowledge on evidence-based shockwave treatments for shoulder pathology. Int J Surg 2015; 24:171-8. [DOI: 10.1016/j.ijsu.2015.08.079] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/28/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022]
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Maier D, Jaeger M, Izadpanah K, Köstler W, Bischofberger AK, Südkamp NP, Ogon P. Arthroscopic Removal of Chronic Symptomatic Calcifications of the Supraspinatus Tendon Without Acromioplasty: Analysis of Postoperative Recovery and Outcome Factors. Orthop J Sports Med 2014; 2:2325967114533646. [PMID: 26535331 PMCID: PMC4555535 DOI: 10.1177/2325967114533646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Little knowledge exists on postoperative recovery of pain and shoulder function following arthroscopic removal of calcific deposits of the supraspinatus tendon (ACDSSP). Certain factors may influence outcome, including acromial morphology. PURPOSE To examine postoperative recovery following ACDSSP without acromioplasty and to analyze influential outcome factors. STUDY DESIGN Case series; Level of evidence, 4. METHODS This prospective study evaluated 82 patients (105 shoulders) after ACDSSP without acromioplasty. Time periods for postoperative recovery of pain and subjective shoulder function were recorded. The absolute and normalized Constant scores (CSabs and CSnorm, respectively), Oxford Shoulder Score (OSS), DASH score (DS), and subjective shoulder value (SSV) were measured after a mean follow-up of 33.9 months. Analyzed outcome factors included localization of the calcific deposit (CD), acromial morphology, radiographic extent of CD removal, type of nonoperative treatment, and preoperative duration of symptoms. RESULTS Mean duration of postoperative pain was 2.2 weeks. Recovery of subjective shoulder function required 11.1 weeks on average. Mean ± standard deviation follow-up values were 91.1 ± 8.3 for CSabs, 104.2% ± 8.2% for CSnorm, 13.1 ± 2.6 for OSS, 1.81 ± 4.59 for DS, and 93.8% ± 10.7% for SSV. Abduction was significantly (P = .008) lower in patients with type III (170° ± 17.5°) compared with type I (174° ± 20.7°) and type II (179° ± 4.5°) acromions. Also, abduction was significantly (P = .001) lower in patients with long-standing symptoms (>72 months). Minor calcific remnants were found in 19 of 105 shoulders (18.1%), but affected neither postoperative recovery nor outcome. CONCLUSION ACDSSP without acromioplasty yielded favorable outcomes and effected fast remission of pain regardless of acromial morphology. However, recovery of subjective shoulder function required almost 3 months on average. Minimal restriction of abduction occurred in patients with hook-shaped acromions and long-standing preoperative symptoms. The present data do not support routine performance of acromioplasty.
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Affiliation(s)
- Dirk Maier
- Department of Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Martin Jaeger
- Department of Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Kaywan Izadpanah
- Department of Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Wolfgang Köstler
- Department of Trauma Surgery, Hospital of Vöcklabruck, Vöcklabruck, Austria
| | - Anne K Bischofberger
- Department of Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Peter Ogon
- Center of Orthopaedic Sports Medicine Freiburg, Freiburg, Germany
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de Witte PB, Henseler JF, Nagels J, Vliet Vlieland TPM, Nelissen RGHH. The Western Ontario rotator cuff index in rotator cuff disease patients: a comprehensive reliability and responsiveness validation study. Am J Sports Med 2012; 40:1611-9. [PMID: 22582227 DOI: 10.1177/0363546512446591] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Western Ontario rotator cuff index (WORC) is an increasingly applied condition-specific outcome measure for rotator cuff (RC) conditions. However, in most WORC validation studies, only a limited number of psychometric properties are studied in indistinct patient groups. PURPOSE To assess psychometric properties of the WORC according to the Scientific Advisory Committee quality criteria for health questionnaires in 3 patient groups with distinct RC conditions. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS The WORC (range, 0-100; 21 items, 5 domains) was administered twice (T1, T2) in 92 patients (35 RC tears, 35 calcific tendinitis, 22 impingement). Additionally, the Constant score (CS) and the Disabilities of the Arm, Shoulder and Hand score (DASH) were recorded. Calcific tendinitis patients were reassessed 6 weeks after treatment with needling and lavage or a subacromial injection with corticosteroids (T3). We assessed floor and ceiling effects, internal consistency, test-retest reliability, precision, construct validity, minimally detectable change, and responsiveness in the diagnostic subgroups and the total group. RESULTS Mean age was 55.0 ± 8.7 years, and 49 of 92 (53%) patients were female. Mean baseline WORC was 46.8 ± 20.4, CS was 63.9 ± 15.4, and DASH was 40.9 ± 18.6. Significant differences were found for the CS and DASH between RC tear patients (severe symptoms) and the other patients, but not for the WORC. There were no floor and ceiling effects. Internal consistency was high: the Cronbach alpha coefficient was .95. The intraclass correlation coefficient of .89 and standard error of measurement of 6.9 indicated high reproducibility. Pearson correlations of the WORC with the CS and DASH were .56 and -.65, respectively (both P < .001). At T3, total WORC improved significantly (mean change, 18.8; 95% confidence interval, 11.3-26.2). Correlations of the WORC change scores with CS and DASH changes were .61 and -.84, respectively (both P < .001). Effect size was 0.96, with a standardized response mean of 0.91, indicating good responsiveness. CONCLUSION Applied to a variety of RC patients, the WORC had high internal consistency, moderate to good construct validity, high test-retest reliability, and good responsiveness. These findings support the use of the WORC as a condition-specific self-reported outcome measure in RC patients, but its validity in patients with severe symptoms needs further investigation.
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Affiliation(s)
- Pieter Bas de Witte
- Department of Orthopaedics, Leiden University Medical Center, Postzone J11R, Postbus 9600, 2300 RC Leiden, The Netherlands.
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Farr S, Sevelda F, Mader P, Graf A, Petje G, Sabeti-Aschraf M. Extracorporeal shockwave therapy in calcifying tendinitis of the shoulder. Knee Surg Sports Traumatol Arthrosc 2011; 19:2085-9. [PMID: 21431373 DOI: 10.1007/s00167-011-1479-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 03/03/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE Strategies for extracorporeal shockwave therapy in calcifying tendinitis of the rotator cuff vary concerning quantity of sessions and doses. The purpose of this prospective pilot study was to determine the difference between the outcome of a single high-dosage extracorporeal shockwave therapy and two sessions of low-dosage extracorporeal shockwave therapy. METHODS This study compared a single high-level middle-energetic extracorporeal shockwave therapy (0.3 mJ/mm(2)) with a low-level middle-energetic extracorporeal shockwave therapy applied twice in a weekly interval (0.2 mJ/mm(2)). Thirty patients that suffered from calcifying tendinitis for at least 6 months received navigated, fluoroscopy-guided extracorporeal shockwave therapy. The gain of Constant Murley Score, Visual Analogue Scale during state of rest and weight-bearing situations ("stress") and radiographic progress was documented 6 and 12 weeks after therapy. RESULTS In both groups, a significant reduction in pain during stress and improvement of function was observed. In contrast, no significant reduction in pain during rest was observed. No significant difference between both groups concerning reduction in the calcific deposit after 6 weeks was detected. Group B showed minor advantages in radiographical improvement after 12 weeks. In 36% of the patients, the calcific deposit completely dissoluted after 12 weeks. CONCLUSIONS This pilot study indicates that a single high-level extracorporeal shockwave therapy may be as effective as two applications of a lower-dosed extracorporeal shockwave therapy for calcifying tendinitis. An effective single-session strategy could reduce treatment time, material costs and healthcare expenses and ionizing radiation in case of fluoroscopy guidance.
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Affiliation(s)
- Sebastian Farr
- Department for Pediatric Orthopaedics, Orthopaedic Hospital Speising, Speisinger Strasse 109, 1130, Vienna, Austria.
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Wessel RN, Lim TE, van Mameren H, de Bie RA. Validation of the Western Ontario Rotator Cuff index in patients with arthroscopic rotator cuff repair: a study protocol. BMC Musculoskelet Disord 2011; 12:64. [PMID: 21453470 PMCID: PMC3087697 DOI: 10.1186/1471-2474-12-64] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 03/31/2011] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Arthroscopic rotator cuff repair is described as being a successful procedure. These results are often derived from clinical general shoulder examinations, which are then classified as 'excellent', 'good', 'fair' or 'poor'. However, the cut-off points for these classifications vary and sometimes modified scores are used.Arthroscopic rotator cuff repair is performed to improve quality of life. Therefore, disease specific health-related quality of life patient-administered questionnaires are needed. The WORC is a quality of life questionnaire designed for patients with disorders of the rotator cuff. The score is validated for rotator cuff disease, but not for rotator cuff repair specifically. The aim of this study is to investigate reliability, validity and responsiveness of WORC in patients undergoing arthroscopic rotator cuff repair. METHODS/DESIGN An approved translation of the WORC into Dutch is used. In this prospective study three groups of patients are used: 1. Arthroscopic rotator cuff repair; 2. Disorders of the rotator cuff without rupture; 3. Shoulder instability. The WORC, SF-36 and the Constant Score are obtained twice before therapy is started to measure reliability and validity. Responsiveness is tested by obtaining the same tests after therapy.
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Affiliation(s)
- Ronald N Wessel
- Department of Orthopedic Surgery, St. Antonius Ziekenhuis, PO Box 2500, 3430 EM Nieuwegein, The Netherlands.
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Sabeti-Aschraf M, Gonano C, Nemecek E, Cichocki L, Schueller-Weidekamm C. Intra-operative ultrasound facilitates the localization of the calcific deposit during arthroscopic treatment of calcifying tendinitis. Knee Surg Sports Traumatol Arthrosc 2010; 18:1792-4. [PMID: 20725715 DOI: 10.1007/s00167-010-1227-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Calcifying tendinitis is a common condition of the shoulder. In many cases, arthroscopic reduction in the deposit is indicated. The localization of the deposit is sometimes challenging and time-consuming. Pre-operative ultrasound (US)-guided needle placement in the deposit and pre-operative US marking of the deposit at the skin with a ballpoint are described and recommended methods to alleviate the procedure without using ionizing radiation by fluoroscopy. METHODS Intra-operative sonography of the shoulder is introduced as a new method to localize the calcific deposit with high accuracy. After standard arthroscopic buresectomy, the surgeon performs an ultrasound examination under sterile conditions to localize the deposits. A ventral longitudinal US section is recommended, and the upper arm is rotated until the deposit is visible. Subsequently, perpendicular to the skin at the position of the transducer, a needle is introduced under arthroscopic and ultrasound visualization to puncture the deposit. RESULTS The presence of snow-white crystals at the tip of the needle proves the exact localization. Consecutively, the curettage can be accomplished. Another intra-operative sonography evaluates possible calcific remnants and the tendon structure. CONCLUSION This new technique may alleviate arthroscopic calcific deposit curettage by visualizing the deposit without using ionizing radiation. Additionally, soft tissue damage due to decreased number of punctures to detect the deposit may be achieved. Both factors may contribute to reduced operation time.
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Affiliation(s)
- M Sabeti-Aschraf
- Department for Orthopaedics and Orthopaedic Surgery, General Hospital of Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Neto AAF, Trevizani CS, Benegas E, Malavolta EA, Gracitelli MEC, Bitar AC, Neto FJDS. ARTHROSCOPIC TREATMENT OF CALCIFYING TENDINITIS OF THE ROTATOR CUFF. Rev Bras Ortop 2010; 45:432-6. [PMID: 27022591 PMCID: PMC4799132 DOI: 10.1016/s2255-4971(15)30432-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED To evaluate the clinical and radiographic results from arthroscopic surgical treatment of the rotator cuff in patients with calcifying tendinitis. METHOD A retrospective study was conducted on twenty patients who underwent arthroscopic treatment for calcifying tendinitis of the shoulder between March 1999 and November 2005. Six patients were excluded due to loss of follow-up. The average follow-up period was 41.4 months. Eight patients (57%) were female and six (43%) were male. The right side was affected in 10 cases (71%) and the left in four cases (29%). Nine cases (64%) had calcification in the supraspinatus tendon, two (14%) in the infraspinatus tendon, and three (21%) in both tendons. RESULTS In all cases, resection of the calcium deposits was performed by means of a needle (Jelco® No. 14) in combination with curettage (mini-curette). Two shoulders (14%) underwent subacromial decompression, and one (7%) underwent excision of the distal clavicle. A tendon-tendon suture was performed in three shoulders (21%). None of the patients underwent tendon-bone reinsertion. The mean score obtained on the UCLA scale was 33 points (26-35), thus indicating that a majority of patients had good results. In the final radiographic evaluation, none of the patients showed signs of calcification. CONCLUSION Arthroscopic treatment of calcifying tendinitis of the shoulder safely allows excision of the calcification, leading to good results in relation to shoulder pain and function.
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Affiliation(s)
| | - Cassio Silva Trevizani
- Trainee Physician in the Shoulder and Elbow Group of the Institute of Orthopedics and Traumatology, HC/FMUSP, SP
| | - Eduardo Benegas
- Attending Physician in the Shoulder and Elbow Group of the Institute of Orthopedics and Traumatology, HC/FMUSP, SP
| | - Eduardo Angeli Malavolta
- Attending Physician in the Shoulder and Elbow Group of the Institute of Orthopedics and Traumatology, HC/FMUSP, SP
| | | | - Alexandre Carneiro Bitar
- Attending Physician in the Shoulder and Elbow Group of the Institute of Orthopedics and Traumatology, HC/FMUSP, SP
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Seyahi A, Demirhan M. Arthroscopic removal of intraosseous and intratendinous deposits in calcifying tendinitis of the rotator cuff. Arthroscopy 2009; 25:590-6. [PMID: 19501287 DOI: 10.1016/j.arthro.2008.12.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 11/24/2008] [Accepted: 12/31/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the surgical outcome of arthroscopic removal of intraosseous deposits in calcifying tendinitis of the rotator cuff. METHODS We studied the results of arthroscopic treatment in 30 shoulders in 28 patients with calcifying tendinitis (mean age, 48.3 years; age range, 26 to 83 years), with a mean follow-up of 38 months. According to the localization of calcification, the patients were divided into 2 groups: those with pure tendinous/soft-tissue involvement (n = 25) (group I) and those with tendinous/soft-tissue and osseous involvement (n = 5) (group II). After routine tendon debridement, debridement and curettage of the bone lesion were also performed in patients with bone involvement. Clinical outcome was evaluated by use of the pain score on a visual analog scale and the Constant score, and a special inquiry was used for self-assessment. RESULTS The pain scores and functional Constant scores improved significantly after the operation in both groups (P = .043 for pain score and P = .0001 for Constant score in group I and P = .042 for pain score and P = .0001 for Constant score in group II). The median Constant score increased from 42 (range, 22 to 65) preoperatively to 100 (range, 80 to 100) postoperatively in group I and from 40 (range, 25 to 55) to 100 (range, 85 to 100) in group II. The mean pain score was 6.5 +/- 1.4 (range, 4 to 9) before treatment and 0.2 +/- 0.5 (range, 0 to 2) at follow-up in group I, and it was 6.2 +/- 1.48 (range, 4 to 8) and 0.4 +/- 0.55 (range, 0 to 1), respectively, in group II. There was no significant difference between the 2 groups in terms of the final Constant (P = .85) and pain scores (P = .26). CONCLUSIONS Arthroscopic removal of intraosseous and intratendinous deposits to treat calcifying tendinitis with osseous involvement seems to be as safe and effective a treatment method as the arthroscopic removal of intratendinous deposits in cases of tendinous involvement only. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Aksel Seyahi
- Department of Orthopaedic Surgery, VKV American Hospital, Istanbul, Turkey
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