Is routine gleno-humeral exploration a risk factor for adhesive capsulitis after arthroscopic removal of rotator cuff calcifications? A comparative retrospective study in 340 cases

Ecalle, Alexandre; Julien, C; Chaouche, Samir; Cungi, Pierre-Julien; Anger, Florent; Galland, Alexandre; Gravier, Renaud; Airaudi, Stéphane

doi:10.1016/j.otsr.2021.102915

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…The pathophysiological link between calcific tendinopathy of the rotator cuff and adhesive capsulitis is not well understood; but chronic micro-leakage of calcium moving from the tendon fibers into the synovial recesses of the joint ( Figure 2 E,F) could be involved (i.e., chronic chemical synovitis) [ 32 ]. Interestingly, some authors have demonstrated that routine arthroscopic glenohumeral exploration performed before the calcification removal is associated with higher risk of post-operative adhesive capsulitis, probably related to the intra-articular diffusion of calcium debris coming from the rotator cuff tendons [ 33 ]. As such, the articular penetration of calcium—as a starter of synovial/capsular inflammation—can be considered to be a very likely link between the two shoulder disorders.…”

Section: Resultsmentioning

confidence: 99%

Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review

et al. 2022

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Shoulder disorders are very common in clinical practice. Among several other pathologies, calcific tendinopathy of the rotator cuff tendons is frequently observed during the ultrasound examination of patients with painful shoulder. The deposition of hydroxyapatite calcium crystals should not be considered as a static process but rather a dynamic pathological process with different/possible patterns of migration. In this paper, we have illustrated how and where these calcium depositions can migrate from the rotator cuff tendons to the peri-articular soft tissues. We have also tried to discuss the issue from the clinical side, i.e., how these particular conditions might impact the specific diagnosis, appropriate rehabilitation plan or interventional approach for optimal functional recovery.

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Section: Resultsmentioning

confidence: 99%

Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review

et al. 2022

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“…The classic arthroscopic portal for ACDs surgery is intra-articular because it makes it possible to assess the lesion of the joint (30% of lesions are associated with ACDs, which may require an additional procedure in 8% of cases) (26). However, the systematic intra-articular approach can lead to complications, such as adhesive capsulitis, as shown by Ecalle et al (27) in the context of calcifications of the rotator cuff. It would appear, however, that this mode of exposure is simpler and more reproducible for approaching the inferior surface of the coracoid process, as described in the arthroscopic Latarjet procedure of Boileau et al (28).…”

Section: Resultsmentioning

confidence: 99%

Does the choice of the optic portal influence the radiographic and early functional results in acute acromioclavicular disjunctions?

Peras¹,

Caubère²,

Amar³

et al. 2022

Acta Orthop Belg

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Exposure of the coracoid process during arthroscopic stabilization of acute acromioclavicular disjunctions (ACDs) can be achieved either by passing an extra- articular optical portal through the subacromial space or by an intra-articular optical route through the glenohumeral joint with opening of the rotator interval. The objective of our study was to compare the impact on the functional results of these two optical routes. This was a retrospective, multicentre study that included patients operated on for an acute acromioclavicular disjunction arthroscopically. The treatment consisted of surgical stabilization under arthroscopy. The surgical indication was retained for an acromioclavicular disjunction of grade 3, 4 or 5, according to the Rockwood classification. Group 1, which consisted of 10 patients, was operated on with an extra-articular subacromial optical route, and group 2, which consisted of 12 patients, was operated on with an intra-articular optical route with opening of the rotator interval according to the habits of the surgeon. A follow-up of 3 months was performed. The functional results were evaluated for each patient using the Constant score, Quick DASH, and SSV. The delays in returning to professional and sports activities were also noted. A precise postoperative radiological analysis made it possible to analyse the quality of the radiological reduction. No significant difference between the two groups was found between the Constant score (88 vs. 90; p = 0.56), Quick DASH (7 vs. 7; p = 0.58), or SSV (88 vs. 93; p = 0.36). The times to return to work (6.8 weeks vs. 7.0 weeks; p = 0.54) and sports activities (15.6 weeks vs. 19.5 weeks; p = 0.53) were also comparable. The quality of the radiological reduction was satisfactory in the two groups and did not depend on the approach. No clinically or radiologically significant differences between the extra-articular and intra-articular optical portals in the surgical treatment of acute ACDs were found. The optical route can be chosen according to the habits of the surgeon.

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“…Our results also showed that arthroscopic surgery for shoulder CT required more recovery time possibly because of the routine diagnostic exploration of the glenohumeral joint during debridement. Ecalle et al 12 conducted a retrospective comparison of 340 cases of shoulder CT and found that glenohumeral joint exploration was routinely performed during arthroscopic surgery, which could lead to shoulder stiffness after surgery. Lang et al 15 found that the probability of shoulder CT with intra-articular lesions was low, and conventional diagnostic glenohumeral joint exploration seemed to have no benefit in treating CT of the shoulder joint during arthroscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Surgery Versus Nonoperative Treatment for Calcific Tendinitis of the Shoulder: A Retrospective Cohort Study

Chen,

Deng,

Liu

et al. 2024

Am J Sports Med

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Background: Treatment options for calcific tendinitis (CT) of the shoulder remain controversial. A consensus for an operative indication for this condition is lacking. Purpose: To compare nonoperative versus operative treatment for shoulder CT and analyze factors affecting the prognosis after treatment. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 180 patients diagnosed with symptomatic CT between January 2017 and September 2021 were evaluated in this retrospective cohort study. There were 103 patients treated nonoperatively at our institution, which included the use of nonsteroidal anti-inflammatory drugs, acupuncture, steroid injections, extracorporeal shock wave therapy, and ultrasound-guided needle aspiration/percutaneous irrigation. However, 77 patients were treated with arthroscopic surgery after 6 months of failed nonoperative treatment. The visual analog scale (VAS) for pain, the Constant-Murley score, and imaging were used to assess and evaluate outcomes. Descriptive data, functional outcomes, and imaging findings were compared between the operative and nonoperative groups before and after propensity score matching. Additionally, prognostic factors including calcium deposit size, tendon infiltration by calcium deposits, involvement of single or multiple tendons, and occurrence of rotator cuff tears were analyzed by comparing the groups to determine their effect on treatment options and recovery. Results: Magnetic resonance imaging showed that the supraspinatus tendon (66.7%) was most commonly involved, followed by the infraspinatus (42.8%) and subscapularis (21.1%) tendons. Tendon infiltration by calcium deposits was observed in 84.4% of the patients, and rotator cuff tears occurred in 30.0% of the patients. After propensity score matching, there was no significant difference in changes in the Constant-Murley score (48.1 ± 25.4 vs 49.0 ± 22.8, respectively; P = .950) and VAS score (4.9 ± 2.3 vs 4.5 ± 1.9, respectively; P = .860) between the operative and nonoperative groups at the final follow-up. However, for patients with shoulder CT and without rotator cuff tears, there was a significant difference in changes in the Constant-Murley score (52.93 ± 25.18 vs 42.13 ± 22.35, respectively; P = .012) and VAS score (5.21 ± 2.06 vs 3.81 ± 1.98, respectively; P < .001) between the operative and nonoperative groups, but the recovery time in the operative group was longer than that in the nonoperative group (86.92 ± 138.56 vs 30.42 ± 54.97 days, respectively; P = .016). The results also showed that calcium deposit size, involvement of multiple tendons, and tendon infiltration by calcium deposits did not affect the recovery time after treatment. The survival analysis showed that rotator cuff tears affected the complete recovery of shoulder function. Conclusion: This study demonstrated no significant difference between nonoperative and operative treatment for patients with shoulder CT, on the whole. However, for patients with shoulder CT and without rotator cuff tears, the effect of operative treatment was better than that of nonoperative treatment; yet, operative treatment was shown to prolong the recovery time. Calcium deposit size, tendon infiltration by calcium deposits, and involvement of multiple tendons did not correlate with recovery time or the recovery of function. A rotator cuff tear was the only factor affecting the complete recovery of shoulder function.

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Is routine gleno-humeral exploration a risk factor for adhesive capsulitis after arthroscopic removal of rotator cuff calcifications? A comparative retrospective study in 340 cases

Cited by 6 publications

References 15 publications

Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review

Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review

Does the choice of the optic portal influence the radiographic and early functional results in acute acromioclavicular disjunctions?

Arthroscopic Surgery Versus Nonoperative Treatment for Calcific Tendinitis of the Shoulder: A Retrospective Cohort Study

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