Comparison of clinical and radiological outcomes after three different surgical treatments for resistant calcifying tendinitis of the shoulder: a short-term randomized controlled trial.

Abstract

Abstract Background: A preferable surgical treatment for patients with conservative therapy resistant calcifying tendinitis of the shoulder is still a matter of debate. Therefore, the purpose of this study was to evaluate and compare short-term clinical and radiological results of three surgical treatment options for these patients. Methods: A multicenter randomized trial was conducted. 69 patients were randomly assigned to receive 1. subacromial decompression (Group SAD), 2. debridement of calcifications (Group D), or 3. debridement of calcifications with SAD (Group D+SAD). Stringent inclusion and exclusion criteria were used. Primary outcome was improvement in VAS for pain (pVAS) six months postoperatively. Secondary outcomes were improvement in pVAS six weeks postoperatively, functional outcome (CMS, DASH, ASES), radiological outcome, side treatments and complications. Results: The improvement in pVAS was significant in all groups (p<0.001) and did not differ between the groups after six months. Six weeks postoperatively, the improvement in pVAS was significantly (p=0.03) less in Group SAD compared to Group D+SAD (16.5mm, SD 19.3mm vs 33.1mm, SD 19.7mm, respectively). The mean size of calcifications decreased significantly in all groups (p<0.0001). In Group SAD the size of the calcifications decreased less (p=0.04) compared to Group D and group D+SAD after six weeks. Group SAD received more side treatments (p=0.003) compared to Group D+SAD (9 vs 1), which were mainly subacromial cortisone injections. Conclusions: All patient groups showed significant pain relief and improvement of shoulder function six months after surgery. However, patients in group SAD showed inferior pain relief and improvement in DASH score after six weeks. Furthermore, this group required more postoperative side treatments. No significant differences in clinical and radiological outcomes were observed between patients in group D compared to group D+SAD. Therefore, an arthroscopic debridement without subacromial decompression seems to be advisable for patients with therapy resistant calcifying tendinitis of the shoulder. Level of evidence: 2, Open Label Randomized Clinical Trial. IRB: METC Zuyderland MC. Number: 14-T-112. Registered at trialregister.nl: NL 4947