Are corticosteroid injections needed after needling and lavage of calcific tendinitis? Randomised, double-blind, non-inferiority trial

Darrieutort-Laffite, Christelle; Varin, Stéphane; Coiffier, Guillaume; Albert, Jean-David; Planche, Lucie; Maugars, Yves; Cormier, Grégoire; Goff, Benoît Le

doi:10.1136/annrheumdis-2018-214971

Cited by 18 publications

(21 citation statements)

References 21 publications

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“…First, conventional NACD+ corticosteroids was compared with NACD + PRP, but there was no placebo control group to evaluate the additive use of corticosteroids or PRP or even the effect on NACD as such. However, a recent study by Darrieutort-Laffite et al 6 compared NACD+ corticosteroids to NACD without corticosteroids. The results of their study demonstrated that NACD+corticosteroids was superior to NACD without corticosteroids in decreasing pain and disability in the short term without any effect on the rate of resorption of calcific deposits.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Adjuvant Application of Platelet-Rich Plasma After Needle Aspiration of Calcific Deposits for the Treatment of Rotator Cuff Calcific Tendinitis: A Double-Blinded, Randomized Controlled Trial With 2-Year Follow-up

et al. 2021

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Background: Needle aspiration of calcific deposits (NACD) is a frequently used treatment for rotator cuff calcific tendinitis (RCCT). However, a substantial number of patients experience recurrent or persisting shoulder symptoms after NACD. Purpose: To compare the effects of adjuvant application of platelet-rich plasma (PRP) after NACD (NACP+PRP) with those of conventional NACD with corticosteroids (NACD+corticosteroids) on pain, shoulder function, and quality of life (QoL). Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In a single-center, double-blinded, randomized controlled trial, 80 adults with symptomatic RCCT were randomly allocated to receive NACD+corticosteroids or NACD+PRP. Pain, shoulder function, and QoL were assessed at baseline; 6 weeks; and 3, 6, 12, and 24 months after treatment using a numeric rating scale for pain (NRS); the Constant-Murley score (CMS); the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH); the Oxford Shoulder Score (OSS); and the EuroQol 5-dimension scale (EQ-5D). Additionally, resorption of calcific deposits and the integrity of rotator cuff tendons were assessed by using standard radiographs and ultrasound examination, respectively. The results were analyzed using noninferiority analysis for NRS scores and a mixed model for repeated measures. Results: Eighty patients were included (48 female; mean age, 49 ± 6 years; 41 patients in the NACD+PRP group). Both groups showed improvement of clinical scores at the 2-year follow-up ( P < .001 for all clinical scores). NACD+PRP was found to be noninferior to NACD+corticosteroids with regard to the mean decrease of NRS scores (4.34 vs 3.56; P = .003). Mixed-model analysis showed a significant difference in favor of NACD+PRP (CMS, P < .001; DASH, P = .002; OSS, P = .010; EQ-5D, P < .001). However, clinically relevant differences in favor of NACD+PRP were only seen at the 6-month follow-up for NRS and CMS scores, whereas at the 6-week follow-up a clinically relevant difference in favor of NACD+corticosteroids was found for all clinical scores except for the NRS. Full resorption of calcific deposits was present in 84% of the NACD+PRP group compared with 66% in the NACD+corticosteroids group ( P = .081). In the NACD+PRP group, 10 (24%) patients required a second NACD procedure compared with 19 (49%) patients in the NACD+corticosteroids group ( P = .036). Six complications, of which 5 were frozen shoulders, occurred in the NACD+PRP group compared with 1 complication in the NACD+corticosteroids group ( P = .11). Conclusion: NACD+PRP resulted in worse clinical scores at the 6-week follow-up but better clinical scores at the 6-month follow-up compared with NACD+corticosteroids. At the 1- and 2-year follow-ups, the results were comparable between groups. Furthermore, PRP seemed to reduce the need for additional treatments but was associated with more complications. In conclusion, NACD+corticosteroids had a favorable early effect on pain and function combined with low comorbidity. Thus, it remains the treatment of choice for patients with RCCT. Registration: NCT02173743 (ClinicalTrials.gov identifier).

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Section: Discussionmentioning

confidence: 99%

Efficacy of Adjuvant Application of Platelet-Rich Plasma After Needle Aspiration of Calcific Deposits for the Treatment of Rotator Cuff Calcific Tendinitis: A Double-Blinded, Randomized Controlled Trial With 2-Year Follow-up

et al. 2021

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“…Interestingly, acute spontaneous resorption of calcific tendinitis was associated with migration of the calcium into the SAB, leading to rapid but painful disappearance of the calcic deposit. 7 UGPL should mimic this mechanism and create a path for the calcium to migrate from the tendon to the bursal cavity.…”

Section: Discussionmentioning

confidence: 99%

“…8,10,19,23 Finally, we and others have found that steroid injections performed after the procedure significantly decreased pain and improved function in the short term but had no added value after 3 months. 7,25 While clinical improvement and the disappearance of calcification are obtained in most patients, some will not improve or will experience a delay in this clinical improvement. Several studies have found an association between persistence of calcification and worse outcome.…”

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confidence: 99%

“…Several studies have found an association between persistence of calcification and worse outcome. 1,7,11 Patients who did not demonstrate improved pain and function in the short or even long term had a greater risk of having no modification to the calcifications on radiograph. Other studies have emphasized the positive correlation between (1) a decrease in the size of the calcification and a change in its aspect and (2) positive outcomes.…”

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Factors Associated With Clinical Improvement and the Disappearance of Calcifications After Ultrasound-Guided Percutaneous Lavage of Rotator Cuff Calcific Tendinopathy: A Post Hoc Analysis of a Randomized Controlled Trial

Dumoulin¹,

Cormier

Varin

et al. 2021

Am J Sports Med

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Background: Calcific tendinitis of the rotator cuff is a frequent cause of shoulder pain. Ultrasound-guided percutaneous lavage (UGPL) is an effective treatment, but factors associated with good clinical and radiological outcomes still need to be identified. Purpose: To study the clinical, procedural, and radiological characteristics associated with improved shoulder function and the disappearance of calcification on radiograph after UGPL. Study Design: Case-control study; Level of evidence, 3. Methods: This is a post hoc analysis of the CALCECHO trial, a double-blinded randomized controlled trial conducted on 132 patients. The trial assessed the effect of corticosteroid injections after UGPL, and patients were randomly assigned to receive either corticosteroid or saline solution in the subacromial bursa. We analyzed all patients included in the randomized controlled trial as 1 cohort. We collected the patients’ clinical, procedural, and radiological characteristics at baseline and during follow-up (3, 6, and 12 months). Univariable analysis, followed by multivariable stepwise regression through forward elimination, was performed to identify the factors associated with clinical success (Disabilities of the Arm, Shoulder and Hand [DASH] score <15) or the disappearance of calcification. Results: Good clinical outcomes at 3 months were associated with steroid injections after the procedure (odd ratio [OR], 3.143; 95% CI, 1.105-8.94). At 6 months, good clinical evolution was associated with a lower DASH score at 3 months (OR, 0.92; 95% CI, 0.890-0.956) and calcium extraction (OR, 10.7; 95% CI, 1.791-63.927). A lower DASH at 6 months was also associated with a long-term favorable outcome at 12 months (OR, 0.939; 95% CI, 0.912-0.966). Disappearance of calcification at 3 and 12 months occurred more frequently in patients in whom communication was created between the calcification and the subacromial bursa during the procedure (OR, 2.728 [95% CI, 1.194-6.234] at 3 months; OR, 9.835 [95% CI, 1.977-48.931] at 12 months). Importantly, an association between calcification resorption and good clinical outcome was found at each time point. Conclusion: Assessing patients at 3 months seems to be an essential part of their management strategy. Calcium extraction and creating a communication between the calcific deposits and subacromial bursa are procedural characteristics associated with good clinical and radiological evolution.

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“…There are many ways to treat CT, and each treatment has its own advantages and disadvantages [7,[35][36][37]. In a recent systematic and network meta-analysis, Wu al.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Results of Arthroscopic Treatment for Calcified Tendinitis of Rotator Cuff—— A Retrospective Study With No Less Than 2 Years Follow Up

Li¹,

Yan²,

Qing³

et al. 2020

Preprint

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Background The treatment of CT remains controversial. The aim of this study was to retrospectively evaluate the pain and functional outcomes of arthroscopic excision with or without rotator cuff repair for treating calcified tendinitis of the rotator cuff.Methods Between Jan 2015 and Apr 2018, a total of 38 patients with 39 shoulders CT of the rotator cuff underwent arthroscopic surgery and were followed for at least two years. The clinical outcomes were evaluated at intervals of 2, 4, and 8 weeks and 3, 6，12 and 24 months after the surgery and annually thereafter. The efficacy measures included the visual analogue scale (VAS) score, University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score and radiographic outcomes.Results All patients underwent follow-ups, and the mean follow-up time was 45.38 months. The VAS score significantly decreased from 73.59±11.35 mm before the surgery to 26.41±10.63 mm at 6 months after surgery and continued to decrease to 5.64±5.02 mm at the end of the follow-up period (all p < 0.01). This result was supported by a significant increase in both the UCLA score and ASES score (all p<0.01) after surgery. Plain radiographs after surgery revealed complete calcification removal in all patients. No recurrence was observed during the follow-up period.Conclusions Arthroscopic excision can relieve pain and improve shoulder joint function in patients with CT. Additional randomized controlled studies need to be conducted to confirm our findings.

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Are corticosteroid injections needed after needling and lavage of calcific tendinitis? Randomised, double-blind, non-inferiority trial

Cited by 18 publications

References 21 publications

Efficacy of Adjuvant Application of Platelet-Rich Plasma After Needle Aspiration of Calcific Deposits for the Treatment of Rotator Cuff Calcific Tendinitis: A Double-Blinded, Randomized Controlled Trial With 2-Year Follow-up

Efficacy of Adjuvant Application of Platelet-Rich Plasma After Needle Aspiration of Calcific Deposits for the Treatment of Rotator Cuff Calcific Tendinitis: A Double-Blinded, Randomized Controlled Trial With 2-Year Follow-up

Factors Associated With Clinical Improvement and the Disappearance of Calcifications After Ultrasound-Guided Percutaneous Lavage of Rotator Cuff Calcific Tendinopathy: A Post Hoc Analysis of a Randomized Controlled Trial

The Clinical Results of Arthroscopic Treatment for Calcified Tendinitis of Rotator Cuff—— A Retrospective Study With No Less Than 2 Years Follow Up

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