Complications associated with arthroscopic treatment of rotator cuff calcifying tendonitis

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Complications associated with arthroscopic
treatment of rotator cuff calcifying tendonitis

• P. CLAVERT, F. SIRVEAUX, P. LOUIS, O. GOSSELIN,
  N. BRASSARD, and the French Society of
  Arthroscopy Shoulder and Elbow Service,
  Orthopaedic department,
• CHU Strasbourg - FRANCE

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The authors state that they have no conflict of
interest regarding this study
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Aims of the study

• Retrospective muticentric study
• Mean follow-up 110m gt9 years
• Clinical and Radiographic revision
• Analyze what are the specific complications
• Per-operative failure deposit has not been found
• Clinical failures CS70 pts
• Radiographic failure persistent deposit at the
  last follow-up

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Patients and Methods

• 450 Shoulders
• 292 F 158 M
• 65 of females
• Mean age 47.4y8,6
• Mean age M vs F (NS)
• Dominant side 60
• Bilateral 74 cases
• Patients activity
• Inactive 17
• Sédentaires 49.5
• Manual workers 33.5

48 y
46,5 y
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Patients and Methods

• Pre-op clinical data
• Constant score 54.5 11.6
• Pain 4,3
• 26 frozen shoulder
• lt120 of elevation
• lt30 of external rotation
• Radiographic data
• Localization
• Supra spinatus
• Multiples deposits 33
• Type of deposit
• Rotator Cuff status
• 5 Ruptures (supra spin)
• Acromion morphology
• Curved or aggressive 50

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Clinical results - global

• Constant at the last FU 82.3 (plt0,001)
• SSV 88.2
• Radiographic results 3 cases (0,7) of a new
  deposit different tendon

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Per-operative failures

• n29 (6,4)
• Associated procedures
• 89.7 Sub-acromial decompression (26)
• 3.4 biceps tenodesis (1)
• 3.4 RC partial lesion debridement (1)

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Per-operative failures

• Final CS79.9 (61-100) 6lt70 (NS)
• Mean gain 25pts (1-81) 5lt10pts
• No correlation with
• Type of deposit
• Localization
• Revision
• Disappeared 62.1 (18)
• Diminished 34.5 (10)
• Persistent 2.9 (1) - type A
• Residual always of type C

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Clinical failures CS70

• n75 (16.7)
• CS 26-70
• 72 Female (NS) 47 years (NS)
• Pre-op symptoms duration 22,6m vs 38,4m (S)
• 7 Rotator cuff lesions partial or full thickness
  (NS)
• Revision - Xrays
• New deposit 1,3 (1)
• Diminished 28 (21)
• Persistent 12 (9)
• Disappeared 58.7 (44)

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Clinical failures CS70

• 19 regional pain syndrome - 10 frozen
  shoulders(S - p0,002)
• Mean gain 13 pts (-20?38)
• 1/3 patients lt10pts
• 1/3 patients between 10-20pts
• 1/3 patients gt20pts
• Influence of the pre-op CS 47 vs 56 (S -
  plt0,0001)
• Predictive factor painful Jobes test (S -
  p0,001)

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Radiographic failures

• n 125
• 3 not found (surgery)
• Final Cst78.6 (32-100)
• 31 patientslt70 Mean gain 25 pts

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Conclusions

• Patients in acute phase (painful or stiff
  shoulder) must not be operated
• Deposit excision has to be total to get good long
  term results
• A progressive disappearance can be observed
  during the first post-op year on Xrays
• A sub-acromial decompression
• In case of mechanical sub-acromial irritation
• if the calcific deposit could not be completely
• The immediate post-operative period is crucial
• Prevent and treat quickly and efficiently post-op
  complications pain and stiffness