Outcomes of surgical repair of partial thickness rotator cuff tears in patients with calcific tendinitis

Abstract

Calcific tendinitis of the rotator cuff is a common disorder and can be successfully treated with non-operative techniques in most cases, although surgical management should be considered in some patients for adequate calcium removal. No clear consensus exists regarding whether the involved tendinous portion to be repaired or not with suture following the deposit removal. The purpose of this study is to evaluate and compare results of re-fixation and debridement of the rotator cuff tendons after calcium removal. Material and methods The study is a retrospective analysis of case histories, operation protocols, magnetic resonance images and radiographs of the shoulder of 19 consecutive patients diagnosed with calcific tendinitis that was surgically treated at our clinic between 2013 and 2016. The median age of the patients was 52 years. All patients were divided into two groups depending on the surgical treatment performed. Calcium deposit was removed and the rotator cuff sutured in patients of the main group, and calcium was removed and the rotator cuff debrided in controls. Results Outcomes were rated as excellent with OSS in 58.3 %, as good in 33.3 % and satisfactory in 8.4 % of the patients in the main group. Controls showed 28.6 % of excellent outcomes and 71.4 % of good results. Excellent ASES shoulder scores were recorded in 91.6 % of the patients in the main group and 8.4 % had satisfactory results. Excellent results were achieved in 71.4 % of controls and 28.6 % had good results. No poor outcomes were observed in the patients. No statistically significant differences were found between the groups. All patients of the main group completely regained the function up to 100 % at a follow-up visit. However, the median time required to regain function by 50 % was 3 months (interquartile range 2:6) after surgery in patients of the main group and 1.5 months in controls. There was a correlation revealed between persistent history of calcific tendinitis and dimensions of the deposit according to the Bosworth classification. Conclusion A type of calcium deposit identified with radiological classifications was shown to have no impact on outcomes. Patients who underwent no repair of the rotator cuff achieved 50 % recovery of the shoulder function almost twice as quickly as those with repaired tendon. No statistically significant differences in outcomes were found between the groups but patients of the main group showed higher scores measured with patient-reported outcomes. More research needs to be carried out on a variety of techniques before definitive conclusions can be made on strategies of surgical treatment of calcific tendonitis.

Calcific Tendinitis: Limited Role of Surgery

“…Whether it is necessary to repair rotator cuff defect after calcific debridement is debatable. Although rotator cuff repair had been reported to have superior functional outcomes, it had been also related to prolonged recovery [42,46,47], and stiffness. Most authors still recommend repairing large defects or encompassing significant thickness of tendon cuff width [48].…”