Prognostic factors for the outcome of needle aspiration of calcific deposits for rotator cuff calcific tendinitis

Abstract

Objective To identify prognostic factors for the effectiveness of needle aspiration of calcific deposits (NACD) for rotator cuff calcific tendinitis (RCCT) Methods One hundred forty-nine patients with symptomatic RCCT were included in a prospective cohort study. Pain (VAS), shoulder function (SST and DASH), and quality of life (EQ-5D) were assessed at baseline and at 3, 6, and 12 months post-NACD. Univariate analyses (independent t tests or Mann-Whitney U tests depending on the distribution of data) were performed to build a multivariable linear regression model. Stepwise regression analysis through backward elimination was performed to evaluate the effect of predefined prognostic factors on the outcome. Results Patients who underwent multiple NACD procedures had less reduction of pain (p < 0.01). Furthermore, a larger reduction in VAS pain scores at 3 months post-NACD was associated with a larger reduction in VAS pain scores at 12 months (p < 0.01). More improvement of SST and DASH scores at 3 months was associated with better SST, DASH, and EQ-5D scores at 12 months (p < 0.01). Smaller-size calcific deposits were associated with less improvement of DASH (p = 0.03) and EQ-5D scores (p = 0.01). A longer duration of symptoms prior to NACD was associated with less improvement of EQ-5D scores (p = 0.01). Conclusions A good initial response after NACD is associated with better outcomes at 12 months. Patients with a longer duration of symptoms prior to NACD and patients who require multiple procedures showed inferior outcomes in terms of pain reduction and improvement of quality of life. Smaller-size calcific deposits are associated with a less favorable outcome of shoulder function and quality of life scores and might therefore be less susceptible for NACD. Key Points • A good initial response to NACD is associated with a better outcome in the longer term. • A longer duration of symptoms and the need for multiple NACD procedures are associated with inferior outcomes. • Smaller-size calcific deposits seem less susceptible for NACD.

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

“…Some authors have reported an increased chance of spontaneous disappearance for type III calcifications. 5,16,27 de Witte et al 12 also found a better outcome for patients undergoing UGPL with type II and III calcifications versus type I. Oudelaar et al 28 found that smaller-sized calcifications had a worse prognosis. We failed to demonstrate the same association using a cutoff of 10 mm to define small calcifications, but we confirmed a weak but significant negative correlation between size and DASH score at 6 months (r = 20.259, P = .003; data not shown).…”

“…Aina et al 1 were the first to describe a relationship between calcium aspiration and the success of the procedure. Some authors, however, were not able to confirm this association, including del Cura et al 11 and Oudelaar et al 28 Moreover, the success of simply fragmenting the calcific deposits without aspiration raised the question of whether it was necessary to perform a lavage of the calcific deposit during the procedure. 19,34 Importantly, we showed that the quantity of calcium extracted was not significantly associated with the outcome.…”

“…Some authors found that the possibility of calcium removal was associated with a favorable outcome, 1 but this association could not be confirmed in other cohorts. 11,28 The efficacy of simple fragmentation of the calcification confirms that calcium removal may not be essential for obtaining significant improvement. 20,34 Finally, a recent prospective cohort study showed that outcome at 3 months was predictive of the final resolution of the symptoms in the long term, emphasizing that patients with no shortterm improvement have a greater risk of having failed UGPL.…”

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

“…In the literature, rates of up to 45% have been published. 35 A possible explanation might be that patients with Gartner and Heyer type 3 calcifications were excluded from participation in this study. It is known that patients with Gartner and Heyer type 1 calcific deposits are more likely to need multiple NACD procedures compared with patients with type 3 calcific deposits.…”

“…It is known that patients with Gartner and Heyer type 1 calcific deposits are more likely to need multiple NACD procedures compared with patients with type 3 calcific deposits. 35 Furthermore, patients were monitored more closely during the study, which could be a possible other explanation for the relatively high rate of secondary procedures.…”