Clinical Follow-up Study Of Total Arthroscopic Treatment Of Rotator Cuff Calcified Tendonitis

[Background]Rotator cuff calcific tendinitis is a disease that causes inflammation around the joints due to calcium deposits in the rotator cuff.It is mainly characterized by pain and restricted mobility.Its pathogenesis is unclear.Treatment methods are divided into conservative treatment and surgical treatment.There are various conservative treatment methods,including rest,non-steroidal anti-inflammatory drugs,subacromial injection,physical therapy,extracorporeal shock wave therapy,needle aspiration lavage,acupuncture,etc.,while surgical treatment is divided into open Surgery and arthroscopic surgery,arthroscopic surgery has become the first choice for surgical treatment because of its minimal invasiveness and fewer postoperative complications.[Objective]To evaluate clinical efficacy and complications of total arthroscopy cleaning to the calcified deposits in the rotator cuff tendon,rotator cuff repair and/or acromioplasty.[Methods]Patients were diagnosed with calcified tendinitis of the rotator cuff from March2016 to June 2020 were selected for this study.Then,according to the criteria of intake and drainage,only 24 patients were included.General information of the enrolled patients were recorded,including age,gender,dominant shoulder joint,surgical shoulder joint,follow-up time,duration of symptoms before surgery,acromion shape,and imaging classification of calcifications.All patients underwent X-ray and CT examinations before the operation.Preoperative tests,final follow-up and clinical evaluation of the healthy side of the shoulder joint were performed using ConstantMurley shoulder function score,University of California Los Angeles shoulder scale(UCLA),Disabilities of the Arm,Shoulder,and Hand(DASH)and American Shoulder and Elbow Surgeons(ASES).The visual analog scale(VAS)was used for pain assessment.In addition,a subjective evaluation of surgical satisfaction was made,which was divided to very satisfactory,satisfactory,fair or poor.During the postoperative and follow-up process,the patients were evaluated by X-ray,CT,and MRI to evaluate the clearance of calcification,recurrence,and the effect of supraspinatus tendon repair.The intraoperative and postoperative complications were recorded.[Results]The follow-up time was 20.7±10.1 months(7-36 months).The postoperative VAS pain score improved significantly from 7.6±0.7 points before surgery to 1.2±0.9 points(P<0.001).All functional scores improved significantly after operation.The Constant score has increased from 49.5 ± 12.7 points before surgery to 85.4 ± 6.7 points after surgery(P<0.001),and the DASH score has decreased from 76.3±11.6 points before surgery to 44.3±5.1 points after surgery(P<0.001).ASES score has increased from35.4±9.1 points before surgery to 85.7±7.3 points after surgery(P<0.001),and the UCLA score has increased from 12.9±3.3 points before surgery to 30.0±2.6 points after surgery(P<0.001).In terms of subjective evaluation,95.8% of the patients thought that the treatment results were very satisfactory or satisfactory(9 cases,14 cases),and4.2%(1 case)of the patients thought the treatment results were acceptable.0 patients thought that the treatment results were poor.Although the patient’s various functions and pain scores were significantly improved,they were still lower than the function and pain scores of the contralateral shoulder joint(P<0.001).Further,there was no residual calcification on X-ray and CT after operation.70% of patients used MRI for tendon integrity assessment at the last follow-up,and there was no rotator cuff tear in the results.15 patients(62.5%)underwent anchor suture repair,and 9 patients(37.5%)underwent lateral suture repair.Furthermore,the last follow-up showed that there was no significant difference in postoperative function and pain scores between the side-to-side suture group and the anchor suture group(P>0.05).There were 19 patients with acromioplasty during the operation and 5 patients without acromioplasty.At the last follow-up,there were no significant differences in the postoperative function and pain scores between the acromioplasty group and the non-acromplasty group(P>0.05).Moreover,during the routine exploration of the glenohumeral joint,the subscapular tendon and the glenohumeral ligament were basically not damaged.SLAP injuries are more common.Among them,15 cases of SLAP Ⅰ-Ⅱ degrees were repaired;2 cases of SLAP Ⅲ injury were treated with tenodesis;7 cases of SLAP had no obvious abnormality.1 patient(4.2%)with postoperative frozen shoulders returned to normal after functional exercises and non-steroidal anti-inflammatory drugs.[Conclusion]Calcification removal,rotator cuff repair and/or acromioplasty under total arthroscopy all have achieved good functional results,but they were still lower than the healthy side.The rotator cuffs of the patients were repaired well after the operation,and the use of lateral suture or anchor suture during the operation had showed a little effect on the function.Therefore,we recommend that Acromioplasty should not be used as a routine operation for calcific tendinitis.