Abstract
Calcific tendinopathy typically affects the shoulder rotator cuff tendons. Its management includes shock wave therapy and US-guided percutaneous irrigation, with surgery being less and less used. Extra-shoulder calcific tendinopathy is relatively infrequent and typically affects the hip. While the diagnostic techniques and the treatment options for shoulder calcific tendinopathy have been extensively described, there are only anecdotic reports on the other sites. In this paper, we have reported an unusual case of non-insertional Achilles calcific tendinopathy which occurred many years after Achilles surgical repair. This condition, which presented similar appearance to that of the rotator cuff calcific tendinopathy, is totally different from the well-known and more common insertional calcific Achilles tendinopathy in terms of pathophysiological, imaging, and clinical findings. Further, we have shown that US-guided percutaneous irrigation might be a safe, technically feasible, mini-invasive, and effective treatment also for Achilles calcific tendinopathy.
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References
Hayes CW, Conway WF. Calcium hydroxyapatite deposition disease. Radiographics. 1990;10:1031–48.
Uhthoff HK, Sarkar K. Calcifying tendinitis. Baillieres Clin Rheumatol. 1989;3:567–81.
Chianca V, Albano D, Messina C, et al. Rotator cuff calcific tendinopathy: from diagnosis to treatment. Acta Biomed. 2018;89:186–96.
Sconfienza LM, Albano D, Allen G, et al. Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus. Eur Radiol. 2018;28:5338–51.
Filippou G, Adinolfi A, Cimmino MA, et al. Diagnostic accuracy of ultrasound, conventional radiography and synovial fluid analysis in the diagnosis of calcium pyrophosphate dihydrate crystal deposition disease. Clin Exp Rheumatol. 2016;34:254–60.
Greis AC, Derrington SM, McAuliffe M. Evaluation and nonsurgical management of rotator cuff calcific tendinopathy. Orthop Clin North Am. 2015;46:293–302.
Yoo JC, Park WH, Koh KH, Kim SM. Arthroscopic treatment of chronic calcific tendinitis with complete removal and rotator cuff tendon repair. Knee Surg Sports Traumatol Arthrosc. 2010;18:1694–9.
Cacchio A, Paoloni M, Barile A, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Phys Ther. 2006;86:672–82.
Serafini G, Sconfienza LM, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F. Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment--nonrandomized controlled trial. Radiology. 2009;252:157–64.
Farin PU, Jaroma H, Soimakallio S. Rotator cuff calcifications: treatment with US-guided technique. Radiology. 1995;195:841–3.
Sconfienza LM, Chianca V, Messina C, Albano D, Pozzi G, Bazzocchi A. Upper limb interventions. Radiol Clin N Am. 2019;57:1073–82.
Chianca V, Orlandi D, Messina C, et al. Interventional therapeutic procedures to treat degenerative and inflammatory musculoskeletal conditions: state of the art. Radiol Med. 2019;124:1112–20.
Arirachakaran A, Boonard M, Yamaphai S, Prommahachai A, Kesprayura S, Kongtharvonskul J. Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs. Eur J Orthop Surg Traumatol. 2017;27:381–90.
Niazi G, Hetta W. The role of ultrasound guided percutaneous needle aspiration and lavage (barbotage) in the treatment of calcific tendinitis. Egypt J Radiol Nucl Med. 2015;46:63–70.
Draghi F, Cocco G, Lomoro P, Bortolotto C, Schiavone C. Non-rotator cuff calcific tendinopathy: ultrasonographic diagnosis and treatment. J Ultrasound. 2019. https://doi.org/10.1007/s40477-019-00393-2.
Kurtoğlu S, Akın L, Kendirci M, Çağlı S, Özgöçmen S. An unusual presentation of parathyroid adenoma in an adolescent: calcific Achilles tendinitis. J Clin Res Pediatr Endocrinol. 2015;7:333–5.
Irwin TA. Current concepts review: insertional Achilles tendinopathy. Foot Ankle Int. 2010;31:933–9.
van Dijk CN, van Sterkenburg MN, Wiegerinck JI, Karlsson J, Maffulli N. Terminology for Achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc. 2011;19:835–41.
Benjamin M, Rufai A, Ralphs JR. The mechanism of formation of bony spurs (enthesophytes) in the Achilles tendon. Arthritis Rheum. 2000;43:576–83.
Ateschrang A, Gratzer C, Weise K. Incidence and effect of calcifications after open-augmented Achilles tendon repair. Arch Orthop Trauma Surg. 2008;128:1087–92.
Kraus R, Stahl JP, Meyer C, et al. Frequency and effects of intratendinous and peritendinous calcifications after open Achilles tendon repair. Foot Ankle Int. 2004;25:827–32.
Leppilahti J, Forsman K, Puranen J, Orava S. Outcome and prognostic factors of Achilles rupture repair using a new scoring method. Clin Orthop Relat Res. 1998;346:152–61.
O'Brien EJ, Frank CB, Shrive NG, Hallgrimsson B, Hart DA. Heterotopic mineralization (ossification or calcification) in tendinopathy or following surgical tendon trauma. Int J Exp Pathol. 2012;93:319–31.
Chun KA, Cho KH. Postoperative ultrasonography of the musculoskeletal system. Ultrasonography. 2015;34:195–205.
Della Valle V, Basi EM, Calliada F. Migration of calcium deposits into subacromial–subdeltoid bursa and into humeral head as a rare complication of calcifying tendinitis: sonography and imaging. J Ultrasound. 2015;18:259–63.
Harries L, Kempson S, Watura R. Calcific tendonitis of the tibialis posterior tendon at the navicular attachment. J Radiol Case Rep. 2011;5:25–30.
de Witte PB, Selten JW, Navas A, et al. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med. 2013;41:1665–73.
Pasquotti G, Faccinetto A, Marchioro U, et al. US-guided percutaneous treatment and physical therapy in rotator cuff calcific tendinopathy of the shoulder: outcome at 3 and 12 months. Eur Radiol. 2016;26:2819–27.
Sconfienza LM, Randelli F, Sdao S, Sardanelli F, Randelli P. Septic bursitis after ultrasound-guided percutaneous treatment of rotator cuff calcific tendinopathy. Pm r. 2014;6:746–8.
Sconfienza LM, Adriaensen M, Albano D, et al. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part I, shoulder. Eur Radiol. 2020;30:903–13.
Silvestri E, Barile A, Albano D, et al. Interventional therapeutic procedures in the musculoskeletal system: an Italian survey by the Italian College of Musculoskeletal Radiology. Radiol Med. 2018;123:314–21.
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Albano, D., Vicentin, I., Messina, C. et al. Post-surgical Achilles calcific tendinopathy treated with ultrasound-guided percutaneous irrigation. Skeletal Radiol 49, 1475–1480 (2020). https://doi.org/10.1007/s00256-020-03453-5
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DOI: https://doi.org/10.1007/s00256-020-03453-5