Clinical and Structural Results of Rotator Cuff Repair Compared With Rotator Cuff Debridement in Arthroscopic Treatment of Calcifying Tendinitis of the Shoulder

Comparing midterm clinical outcome of surgical versus ultrasound guided needle aspiration of the calcific deposits for therapy resistant calcifying tendinitis of the shoulder. A comparative cohort study

PURPOSE

Comparing the midterm clinical outcome of surgical treatment versus ultrasound guided needle aspiration of the calcific deposits (NACD) treatment for conservative therapy resistant calcifying tendinitis (CT) of the shoulder. The hypothesis is that both surgical treatment and NACD treatment led to a comparable good clinical outcome.

METHODS

A comparative cohort study was performed (n = 76). The allocation to surgical group (n = 35) or NACD group (n = 41) was the result of a shared decision-making strategy. Primary outcome was decrease in VAS for pain (pVAS). Secondary outcomes were EQ-5D index, DASH score, ASES, VAS for satisfaction, recommendation of treatment, adverse events, cross-over between groups, additional treatments, and symptomatology after care as usual.

RESULTS

At midterm follow-up (5.5 years, SD 0.5 years) decrease in pVAS did not differ (p = 0.20) between two groups (60.6 mm, SD 23.3 mm vs 53.4 mm, SD 24.2 mm). Secondary clinical outcomes were also comparable. In 68.3% surgical treatment was avoided. At final follow-up none of the outcome scores differed significantly between the crossed-over patients (n = 13, 31.7%) and the initial surgical group.

DISCUSSION

At midterm follow-up surgical and NACD treatment result in comparable clinical outcomes. In 68.3% a surgical treatment could be avoided. In 31.7% the patient eventually needed a surgical treatment after failed NACD treatment. After midterm follow-up these patients showed comparable good clinical outcomes. In our opinion, both NACD and surgical treatment could be considered as a next step treatment option for conservative therapy resistant CT of the shoulder. Though, one should be aware that after a midterm follow-up a high number of patients cross-over to surgical treatment after a NACD treatment.

Treatment of Calcific Tendonitis of the Rotator Cuff: An Updated Review

Rotator cuff calcific tendonitis (RCCT) is a disorder that can greatly impair patients' quality of life. A literature review was conducted to find the most effective and newest treatments for RCCT. PubMed and Cochrane Review databases were searched, without strict inclusion/exclusion criteria, for peer-reviewed articles between 1941 and 2021 that discussed RCCT etiology and treatments. If nonoperative measures (non-steroidal anti-inflammatory drugs, physical therapy, and corticosteroids) are unsuccessful, other options include extracorporeal shockwave therapy, ultrasound-guided injection techniques, and minimally invasive surgery. Because RCCT can resolve spontaneously, patients should progress to invasive options only if conservative first-line treatments have failed. [Orthopedics. 2023;46(6):e326-e332.].

Rotator cuff debridement compared with rotator cuff repair in arthroscopic treatment of calcifying tendinitis of the shoulder: A systematic review and meta-analysis

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.

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

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.