Comparison of clinical and radiological outcomes after three different surgical treatments for resistant calcifying tendinitis of the shoulder: a short-term randomized controlled trial

• Published in: Journal of orthopaedic surgery and research Vol. 17; no. 1; pp. 1 - 480
• Main Authors: Verstraelen, Freek, Schotanus, Martijn, Klemann-Harings, Steffie, Lambers Heerspink, Okke, Jansen, Edwin
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 05.11.2022; BioMed Central; BMC
• Subjects: Arthritis; Calcification; Calcifying tendinitis; Care and treatment; Clinical trials; Comparative analysis; Debridement; Decompression; Nonsteroidal anti-inflammatory drugs; Orthopedics; Osteoarthritis; Pain; Pathology; Patients; Rotator cuff; Shoulder; Subacromial decompression; Surgery; Surgical treatment; Tendinitis; Ultrasonic imaging
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-022-03373-1

Abstract Background A preferable surgical treatment for patients with conservative therapy-resistant calcifying tendinitis of the shoulder is still a matter of debate. Therefore, the purpose of this study was to evaluate and compare short-term clinical and radiological results of three surgical treatment options for these patients. Methods A multicenter randomized trial was conducted. Sixty-nine patients were randomly assigned to receive 1. subacromial decompression (Group SAD), 2. debridement of calcifications (Group D), or 3. debridement of calcifications with SAD (Group D + SAD). Stringent inclusion and exclusion criteria were used. The primary outcome was an improvement in VAS for pain (pVAS) 6 months postoperatively. Secondary outcomes were an improvement in pVAS 6 weeks postoperatively, functional outcomes (CMS, DASH, ASES), radiological outcome, additional treatments, and complications. Results The improvement in pVAS was significant in all groups ( p  < 0.001) and did not differ between the groups after 6 months. Six weeks postoperatively, the improvement in pVAS was significantly ( p  = 0.03) less in Group SAD compared to Group D + SAD (16.5 mm, SD 19.3 mm vs 33.1 mm, SD 19.7 mm, respectively). The mean size of calcifications decreased significantly in all groups ( p  < 0.0001). In Group SAD, the size of the calcifications decreased less ( p  = 0.04) compared to Group D and Group D + SAD after 6 weeks. Group SAD received more additional treatments ( p  = 0.003) compared to Group D + SAD (9 vs 1), which were mainly subacromial cortisone injections. Conclusions All patient groups showed significant pain relief and an improvement in shoulder function 6 months after surgery. However, patients in Group SAD showed inferior pain relief and less improvement in DASH score after 6 weeks. Furthermore, this group required more postoperative additional treatments. No significant differences in clinical and radiological outcomes were observed between patients in Group D compared to Group D + SAD. Therefore, an arthroscopic debridement without subacromial decompression seems to be advisable for patients with therapy-resistant calcifying tendinitis of the shoulder. Level of evidence 2, Open-Label Randomized Clinical Trial. IRB METC Zuyderland MC. Number: 14-T-112. Registered at trialregister.nl NL 4947.