Department of Shoulder Surgery and Sports Traumatology, Schoen-Clinic Lorsch, Lorsch, Germany.
Department of Orthopaedic Surgery, Saarland University, Homburg (Saar), Germany.
Am J Sports Med. 2021 Oct;49(12):3196-3201. doi: 10.1177/03635465211037690. Epub 2021 Sep 16.
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.
To evaluate the structural and clinical results after arthroscopic calcific deposit removal with additional rotator cuff repair or rotator cuff debridement.
Cohort study; Level of evidence, 3.
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.
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; = .04), the ASES score (98.3 vs 88.9; = .004), the Simple Shoulder Test (11.6 vs 10; = .005), and the numerical rating scales for pain (0.1 vs 0.8; = .007), function (9.6 vs 8.8; = .008), and satisfaction (9.8 vs 9.1; = .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 ( = .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.
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.
关节镜治疗肩钙化性肌腱炎的效果良好至极好。然而，在去除钙化沉积物后，肌腱是否需要修复或仅仅进行清创仍不清楚。
评估关节镜下钙化沉积物清除后附加肩袖修复或肩袖清创的结构和临床结果。
队列研究；证据水平，3 级。
本回顾性队列研究共纳入 44 例患者（46 肩），平均随访 58.4 个月。患者在非手术治疗失败后接受关节镜下钙化沉积物清除和滑囊切除术。共有 22 例患者接受了附加的肩袖修复，无论清创程度如何（修复组），而 22 例患者接受了单纯的肩袖清创（清创组）。根据 Gärtner 和 Bosworth 分类，两组在性别、年龄、沉积物的大小和一致性方面具有可比性。临床评估采用 Constant 评分、简易肩部测试、美国肩肘外科医师协会（ASES）评分以及疼痛、功能和满意度的数字评分量表进行。在 29 例患者（清创组 14 例，修复组 15 例）中，在随访时进行了额外的磁共振成像，以使用 Sugaya 分类评估结构结果。
所有患者对手术结果均满意；修复组和清创组的患者均报告 100%会再次接受手术。与清创组相比，修复组的临床结果明显更好，Constant 评分（分别为 86.2 和 80.6； =.04）、ASES 评分（分别为 98.3 和 88.9； =.004）、简易肩部测试（分别为 11.6 和 10； =.005）以及疼痛（分别为 0.1 和 0.8； =.007）、功能（分别为 9.6 和 8.8； =.008）和满意度（分别为 9.8 和 9.1； =.036）的评分更高。术后肌腱完整性比较显示，肩袖修复组的 Sugaya 分级Ⅰ级为 80%，清创组为 64%，修复组的差异具有统计学意义（ =.004）。修复组术后临床检查无 O'Brien 试验阳性，而清创组约三分之一的患者检查时 O'Brien 试验阳性。
关节镜下钙化沉积物清除联合肩袖清创或修复术可获得良好至极好的临床和中期结构结果。然而，接受肌腱缺损附加修复的患者具有明显更好的临床结果，以及在肌腱完整性方面更好的结构结果。
