Background:

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.

Purpose:

To evaluate the structural and clinical results after arthroscopic calcific deposit removal with additional rotator cuff repair or rotator cuff debridement.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

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.

Results:

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; P = .04), the ASES score (98.3 vs 88.9; P = .004), the Simple Shoulder Test (11.6 vs 10; P = .005), and the numerical rating scales for pain (0.1 vs 0.8; P = .007), function (9.6 vs 8.8; P = .008), and satisfaction (9.8 vs 9.1; P = .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 (P = .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.

Conclusion:

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.

中文翻译：

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肩袖修复术与肩袖清创术在关节镜治疗肩部钙化性肌腱炎中的临床和结构结果

背景：

肩关节钙化性肌腱炎的关节镜治疗显示出良好至极好的效果。然而，在去除钙化沉积物后是否需要修复肌腱或简单地清创仍不清楚。

目的：

评估关节镜下钙化沉积物去除并附加肩袖修复或肩袖清创后的结构和临床结果。

学习规划：

队列研究；证据级别，3。

方法：

共有 44 名患者（46 个肩膀）参加了这项回顾性队列研究，平均随访时间为 58.4 个月。在非手术治疗失败后，患者接受了关节镜下钙化沉积物去除和滑囊切除术。无论清创程度如何，共有 22 名患者接受了额外的肩袖修复（修复组），而 22 名患者接受了没有额外修复的简单肩袖清创（清创组）。根据 Gärtner 和 Bosworth 分类，各组在性别、年龄、大小和沉积物的一致性方面具有可比性。通过恒定评分、简单肩部测试、美国肩肘外科医生 (ASES) 评分以及疼痛、功能和满意度的数字评定量表进行临床评估。

结果：

所有患者均对手术结果表示满意；100% 的修复组和 95.7% 的清创组报告他们将再次接受外科手术。临床结果的比较显示，修复组与清创组在 Constant 评分（分别为 86.2 对 80.6；P = .04）、ASES 评分（98.3 对 88.9；P = .004）、Simple肩部测试（11.6 对 10；P = .005），以及疼痛（0.1 对 0.8；P = .007）、功能（9.6 对 8.8；P = .008）和满意度（9.8 对 9.1；磷= .036）。术后肌腱完整性比较显示，肩袖修复组为 80% 的 Sugaya I 级，清创组为 64% 的 Sugaya II 级，有统计学意义的差异有利于修复组 ( P = .004)。术后临床评估显示修复组的 O'Brien 试验未呈阳性，而清创组中约有三分之一在检查期间显示 O'Brien 试验阳性。

结论：

用肩袖清创术或袖带修复的关节镜去除钙化沉积物显示出良好至极好的临床和结构中期结果。然而，接受额外肌腱缺损修复的患者在肌腱完整性方面具有明显更好的临床结果以及更好的结构结果。