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Intraosseous calcific tendinitis of the rotator cuff yields similar outcomes to those of intratendinous lesions despite worse preoperative scores

Abstract

Purpose

To evaluate the surgical outcomes of arthroscopic removal of intraosseous deposits in patients with intraosseous calcific tendinitis of the rotator cuff.

Methods

This study involved a retrospective review of 96 patients operated on from 2004 to 2019. Patients were divided into two groups according to the location of calcific deposits. Group I had pure tendinous involvement (n = 71), and Group II had tendinous and intraosseous involvement (n = 25). The mean follow-up time was 6.4 ± 3.9 years. There were 71 patients (46 women, 25 men) in Group I, and the mean age was 49.3 ± 8.2 years (range 30–65 years). In group II, there were 25 patients (18 women, 7 men); the mean age was 47.3 ± 11.2 years (range 28–70 years).

Results

The mean preoperative VAS pain score was 8.8 ± 1.4 in Group I compared to 9.5 ± 0.5 in group II (p = 0.017). The median preoperative Constant and Oxford scores were 42 (20–65) and 22 (8–34) in Group I and 25.5 (22–46) and 10 (8–16) in group II, respectively (p < 0.001). There was no difference in postoperative pain scores (Group I: 0.7 ± 1.6 and group II: 0.5 ± 0.6, p = 0.926), Constant scores [Group I: 100 (80–100) and group II: 100 (90–100), (n.s).] and Oxford scores [Group I: 48 (28–48) and group II: 46.5 (4–48), (n.s.)] between the two groups. The number of preoperative injections was higher in Group II (p = 0.05). There was no correlation between the size of the soft tissue calcific deposit and the preoperative pain, Constant, and Oxford scores (n.s.).

Conclusion

Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement.

Level of evidence

III.

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References

  1. Albano D, Coppola A, Gitto S, Rapisarda S, Messina C, Sconfienza LM (2021) Imaging of calcific tendinopathy around the shoulder: usual and unusual presentations and common pitfalls. Radiol Med 126(4):608–619

    Article  Google Scholar 

  2. Ark JW, Flock TJ, Flatow EL, Bigliani LU (1992) Arthroscopic treatment of calcific tendinitis in the shoulder. Arthroscopy 8:183–188

    CAS  Article  Google Scholar 

  3. Balke M, Banerjee M, Vogler T, Akoto R, Bouillon B, Liem D (2014) Acromial morphology in patients with calcific tendinitis of the shoulder. Knee Surg Sports Traumatol Arthrosc 22(2):415–421

    Article  Google Scholar 

  4. Balke M, Bielefeld R, Schmidt C, Dedy N, Liem D (2012) Calcifying tendinitis of the shoulder: midterm results after arthroscopic treatment. Am J Sports Med 40(3):657–661

    Article  Google Scholar 

  5. Beckmann NM, Tran MQ, Cai C (2019) Incidence of rotator cuff tears in the setting of calcific tendinopathy on MRI: a case controlled comparison. Skeletal Radiol 48:245–250

    Article  Google Scholar 

  6. Brinkman JC, Zaw TM, Fox MG, Wilcox JG, Hattrup SJ, Chhabra A, Neville MR, Hartigan DE (2020) Calcific tendonitis of the shoulder: protector or predictor of cuff pathology? A magnetic resonance imaging-based study. Arthroscopy 36(4):983–990

    Article  Google Scholar 

  7. Buyukdogan K, Aslan L, Koyuncu Ö, Eren İ, Birsel O, Fox MA et al (2021) Long term outcomes after arthroscopic transosseous equivalent repair: clinical and MRI results of rotator cuff tears at a minimum follow-up of 10 years. J Shoulder Elb Surg. https://doi.org/10.1016/j.jse.2021.04.034

    Article  Google Scholar 

  8. Buyukdogan K, Koyuncu O, Eren I, Birsel O, Fox MA, Demirhan M (2019) Arthroscopic knotless separate layer transosseous equivalent repair of delaminated rotator cuff tears. Arthrosc Tech 8:1193–1200

    Article  Google Scholar 

  9. Chianca V, Albano D, Messina C, Midiri F, Mauri G, Aliprandi A et al (2018) Rotator cuff calcific tendinopathy: from diagnosis to treatment. Acta Biomed 89:186–196

    PubMed  PubMed Central  Google Scholar 

  10. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Article  Google Scholar 

  11. Dawson J, Rogers K, Fitzpatrick R, Carr A (2009) The Oxford shoulder score revisited. Arch Orthop Trauma Surg 129:119–123

    Article  Google Scholar 

  12. Drummond Junior M, Ayinon C, Rodosky M, Vyas D, Lesniak B, Lin A (2021) Predictive factors for failure of conservative management in the treatment of calcific tendinitis of the shoulder. JSES Int 5(3):469–473

    Article  Google Scholar 

  13. Dumoulin N, Cormier G, Varin S, Coiffier G, Albert JD, Le Goff B et al (2021) Factors associated with clinical improvement and the disappearance of calcifications after ultrasound-guided percutaneous lavage of rotator cuff calcific tendinopathy: a post hoc analysis of a randomized controlled trial. Am J Sports Med 49(4):883–891

    Article  Google Scholar 

  14. Flemming DJ, Murphey MD, Shekitka KM, Temple HT, Jelinek JJ, Kransdorf MJ (2003) Osseous involvement in calcific tendinitis: a retrospective review of 50 cases. Am J Roentgenol 181:965–972

    Article  Google Scholar 

  15. Gwalani R, Thombare P, Verma M, Ahuja G, Patkar D (2020) MRI findings in intraosseous extension of calcific supraspinatus tendonitis. Radiol Case Rep 15(7):975–977

    Article  Google Scholar 

  16. Hayes CW, Rosenthal DI, PlataMJ HTM (1987) Calcific tendinitis in unusual sites associated with cortical bone erosion. Am J Roentgenol 149:967–970

    CAS  Article  Google Scholar 

  17. Hutchinson JL, Gusberti D, Saab G (2019) Changing appearance of intraosseous calcific tendinitis in the shoulder with time: a case report. Radiol Case Rep 14(10):1267–1271

    Article  Google Scholar 

  18. Jain TP, Damiani M (2020) Calcific tendinosis of rotator cuff with intraosseous extension. J Med Imaging Radiat Oncol 64(2):250–251

    Article  Google Scholar 

  19. Jerosch J, Strauss JM, Schmiel S (1998) Arthroscopic treatment of calcific tendonitis of the shoulder. J Shoulder Elb Surg 7:30–37

    CAS  Article  Google Scholar 

  20. Klontzas ME, Vassalou EE, Karantanas AH (2017) Calcific tendinopathy of the shoulder with intraosseous extension: outcomes of ultrasound-guided percutaneous irrigation. Skelet Radiol 46:201–208

    Article  Google Scholar 

  21. Lanza E, Banfi G, Serafini G, Lacelli F, Orlandi D, Bandirali M et al (2015) Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting. Eur Radiol 25:2176–2183

    Article  Google Scholar 

  22. Louwerens JKG, Sierevelt IN, Kramer ET, Boonstra R, van den Bekerom MPJ, van Royen BJ et al (2020) Comparing ultrasound-guided needling combined with a subacromial corticosteroid injection versus high-energy extracorporeal shockwave therapy for calcific tendinitis of the rotator cuff: a randomized controlled trial. Arthroscopy 36(7):1823–1833

    Article  Google Scholar 

  23. Louwerens JK, Veltman ES, van Noort A, van den Bekerom MP (2016) The effectiveness of high-energy extracorporeal shockwave therapy versus ultrasound-guided needling versus arthroscopic surgery in the management of chronic calcific rotator cuff tendinopathy: a systematic review. Arthroscopy 32(1):165–175

    Article  Google Scholar 

  24. Maier M, Schmidt-Ramsin J, Glaser C, Kunz A, Kuchenhoff H, Tischer T (2008) Intra- and interobserver reliability of classification scores in calcific tendinitis using plain radiographs and CT scans. Acta Orthop Belg 74:590–595

    PubMed  Google Scholar 

  25. Marinetti A, Sessa M, Falzone A, Della Sala SW (2018) Intraosseous migration of tendinous calcifications: two case reports. Skelet Radiol 47(1):131–136

    CAS  Article  Google Scholar 

  26. Miranda I, Sánchez-Alepuz E, Díaz-Martínez JV, Collado-Sánchez A, Peregrín-Nevado I (2020) Calcific tendinopathy of the shoulder with intraosseous extension: experience with arthroscopic treatment and review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 64(1):13–21

    CAS  Google Scholar 

  27. Oudelaar BW, Huis In’t Veld R, Schepers-Bok R, Ooms EM, Nelissen RGHH, Vochteloo AJH (2020) Prognostic factors for the outcome of needle aspiration of calcific deposits for rotator cuff calcific tendinitis. Eur Radiol 30(7):4082–4090

    Article  Google Scholar 

  28. Porcellini G, Paladini P, Campi F, Paganelli B (2004) Arthroscopic treatment of calcifying tendinitis of the shoulder: clinical and ultrasonographic follow-up findings at two to five years. J Shoulder Elb Surg 13:503–508

    Article  Google Scholar 

  29. Sansone V, Maiorano E, Galluzzo A, Pascale V (2018) Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment. Orthop Res Rev 10:63–72

    PubMed  PubMed Central  Google Scholar 

  30. Seyahi A, Demirhan M (2009) Arthroscopic removal of intraosseous and intratendinous deposits in calcifying tendinitis of the rotator cuff. Arthroscopy 25:590–596

    Article  Google Scholar 

  31. Zampa V, Aringhieri G, Rossi P, Capanna R, Caramella D (2021) Humeral greater tuberosity osteolysis as a complication of intraosseous calcification migration: natural history depicted by imaging. Acta Biomed. https://doi.org/10.23750/abm.v92iS1.8370

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Emrah Caliskan.

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Caliskan, E., Eren, I., Aslan, L. et al. Intraosseous calcific tendinitis of the rotator cuff yields similar outcomes to those of intratendinous lesions despite worse preoperative scores. Knee Surg Sports Traumatol Arthrosc 30, 2485–2491 (2022). https://doi.org/10.1007/s00167-022-06870-2

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Keywords

  • Calcifying tendinitis
  • Arthroscopy
  • Intraosseous calcifying tendinitis
  • Intratendinous calcifying tendinitis
  • Rotator cuff
  • Calcific tendonitis