Efficacy of ultrasound-guided percutaneous lavage for rotator cuff calcific tendinopathy: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Xin ¹ , YU Yating ¹ , SHAO Gaohai ² , ZHANG Zhongzu ² ,  ZHANG Xiaohua ¹

1. Department of Orthopedics, Jiangjin Centre Hospital, Chongqing, 402260, P.R.China;
2. Department of Orthopedics, the Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, P.R.China;

Corresponding author：

ZHANG Xiaohua, Email: zxhxjz@163.com

Keywords：

Tendinopathy; Calcinosis; Shoulder; Ultrasonics; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201711004

Video：

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ObjectivesTo systematically review the clinical efficacy of ultrasound-guided percutaneous lavage (UGPL) for calcifying tendinitis of rotator cuff.MethodsPubMed, The Cochrane Library, EMbase, WanFang Data, CBM, VIP and CNKI databases were electronically searched to collect the randomized controlled trials (RCTs) of ultrasound-guided percutaneous irrigation for calcifying tendinitis of rotator cuff from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 7 RCTs involving 587 patients were included. The results of meta-analysis showed that: there were significant differences between the UGPL group and extracorporeal shock wave therapy (ESWT) group in 12-month follow-up visual analogue scale (VAS) (MD=–1.96, 95%CI –2.18 to –1.75, P<0.000 01), the average particle size of the calcium deposition (MD=–3.13, 95%CI –5.05 to –1.22,P<0.001), the calcification disappearance rate (RR=1.65, 95%CI 1.36 to 2.01,P<0.000 01). However, there were no significant differences between the two groups in 6-week follow-up VAS (MD=–0.85, 95%CI –2.84 to 1.14,P=0.40), and the complications (RR=1.20, 95%CI 0.03 to 49.69, P=0.93).ConclusionsCurrent evidence shows that UGPL has certain clinical effect for the calcifying tendinitis of rotator cuff. Compared with ESWT, UGPL may be superior in clinical pain relief and calcification clearance. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： ZHOU Xin, YU Yating, SHAO Gaohai, ZHANG Zhongzu, ZHANG Xiaohua. Efficacy of ultrasound-guided percutaneous lavage for rotator cuff calcific tendinopathy: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(7): 676-682. doi: 10.7507/1672-2531.201711004 Copy

1.	Wainner RS, Hasz M. Management of acute calcific tendinitis of the shoulder. J Orthop Sports Phys Ther, 1998, 27(3): 231-237.
2.	Uhthoff HK, Sarkar K, Maynard JA. Calcifying tendinitis: a new concept of its pathogenesis. Clin Orthop Relat Res, 1976, (118): 164-168.
3.	ElShewy MT. Calcific tendinitis of the rotator cuff. World J Orthop, 2016, 7(1): 55-60.
4.	商晓军, 李欢, 丁文鸽, 等. 关节镜治疗钙化性冈上肌腱炎的疗效观察. 中国矫形外科杂志, 2015, 23(17): 1621-1623.
5.	Arirachakaran A, Boonard M, Yamaphai S, et al. Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs. Eur J Orthop Surg Traumatol, 2017, 27(3): 381-390.
6.	Greis AC, Derrington SM, McAuliffe M. Evaluation and nonsurgical management of rotator cuff calcific tendinopathy. Orthop Clin North Am, 2015, 46(2): 293-302.
7.	Vignesh KN, McDowall A, Simunovic N, et al. Efficacy of ultrasound-guided percutaneous needle treatment of calcific tendinitis. AJR Am J Roentgenol, 2015, 204(1): 148-152.
8.	Bazzocchi A, Pelotti P, Serraino S, et al. Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome. Br J Radiol, 2016, 89(1057): 20150407.
9.	王前源, 刘水涛, 卫小春, 等. 体外冲击波疗法治疗肩袖钙化性肌腱炎的荟萃分析. 中国医学前沿杂志 (电子版), 2017, 9(2): 1-6, 173.
10.	De Boer FA, Mocking F, Nelissen EM, et al. Ultrasound guided needling vs. radial shockwave therapy in calcific tendinitis of the shoulder: a prospective randomized trial. J Orthop, 2017, 14(4): 466-469.
11.	Federico CG, Ramos-Alvarez JJ, Rodríguez-Fabián G, et al. Extracorporeal shockwaves versus ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a randomized controlled trial. Eur J Phys Rehabil Med, 2016, 52(2): 145-151.
12.	Kim YS, Lee HJ, Kim YV, et al. Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. J Shoulder Elbow Surg, 2014, 23(11): 1640-1646.
13.	de Witte PB, Selten JW, Navas A, et al. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med, 2013, 41(7): 1665-1673.
14.	Zhang J, Ebraheim N, Lause GE. Ultrasound-guided injection for the biceps brachii tendinitis: results and experience. Ultrasound Med Biol, 2011, 37(5): 729-733.
15.	Zhu J, Jiang Y, Hu Y, et al. Evaluating the long-term effect of ultrasound-guided needle puncture without aspiration on calcifying supraspinatus tendinitis. Adv Ther, 2008, 25(11): 1229-1234.
16.	Krasny C, Enenkel M, Aigner N, et al. Ultrasound-guided needling combined with shock-wave therapy for the treatment of calcifying tendonitis of the shoulder. J Bone Joint Surg Br, 2005, 87(4): 501-507.
17.	Speed CA, Hazleman BL. Calcific tendinitis of the shoulder. N Engl J Med, 1999, 340(20): 1582-1584.
18.	Lanza E, Banfi G, Serafini G, et al. Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting. Eur Radiol, 2015, 25(7): 2176-2183.
19.	Niazi G, Hetta W. The role of ultrasound guided percutaneous needle aspiration and lavage (barbotage) in the treatment of calcific tendinitis. J Radiol Nucl Med, 2015, 46(1): 63-70.
20.	del Cura JL, Torre I, Zabala R, et al. Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results. AJR Am J Roentgenol, 2007, 189(3): W128-W134.
21.	Lin JT, Adler RS, Bracilovic A, et al. Clinical outcomes of ultrasound-guided aspiration and lavage in calcific tendinosis of the shoulder. HSS J, 2007, 3(1): 99-105.
22.	Yoo JC, Koh KH, Park WH, et al. The outcome of ultrasound-guided needle decompression and steroid injection in calcific tendinitis. J Shoulder Elbow Surg, 2010, 19(4): 596-600.
23.	De Zordo T, Ahmad N, Ødegaard F, et al. US-guided therapy of calcific tendinopathy: clinical and radiological outcome assessment in shoulder and non-shoulder tendons. Ultraschall Med, 2011, 32 Suppl 1: S117-S123.
24.	Sconfienza LM, Bandirali M, Serafini G, et al. Rotator cuff calcific tendinitis: does warm saline solution improve the short-term outcome of double-needle US-guided treatment? Radiology, 2012, 262(2): 560-566.
25.	Merolla G, Bianchi P, Porcellini G. Ultrasound-guided subacromial injections of sodium hyaluronate for the management of rotator cuff tendinopathy: a prospective comparative study with rehabilitation therapy. Musculoskelet Surg, 2013, 97 Suppl 1: 49-56.
26.	Aina R, Cardinal E, Bureau NJ, et al. Calcific shoulder tendinitis: treatment with modified US-guided fine-needle technique. Radiology, 2001, 221(2): 455-461.
27.	Sconfienza LM, Randelli F, Sdao S, et al. Septic bursitis after ultrasound-guided percutaneous treatment of rotator cuff calcific tendinopathy. PMR, 2014, 6(8): 746-748.

1. Wainner RS, Hasz M. Management of acute calcific tendinitis of the shoulder. J Orthop Sports Phys Ther, 1998, 27(3): 231-237.
2. Uhthoff HK, Sarkar K, Maynard JA. Calcifying tendinitis: a new concept of its pathogenesis. Clin Orthop Relat Res, 1976, (118): 164-168.
3. ElShewy MT. Calcific tendinitis of the rotator cuff. World J Orthop, 2016, 7(1): 55-60.
4. 商晓军, 李欢, 丁文鸽, 等. 关节镜治疗钙化性冈上肌腱炎的疗效观察. 中国矫形外科杂志, 2015, 23(17): 1621-1623.
5. Arirachakaran A, Boonard M, Yamaphai S, et al. Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs. Eur J Orthop Surg Traumatol, 2017, 27(3): 381-390.
6. Greis AC, Derrington SM, McAuliffe M. Evaluation and nonsurgical management of rotator cuff calcific tendinopathy. Orthop Clin North Am, 2015, 46(2): 293-302.
7. Vignesh KN, McDowall A, Simunovic N, et al. Efficacy of ultrasound-guided percutaneous needle treatment of calcific tendinitis. AJR Am J Roentgenol, 2015, 204(1): 148-152.
8. Bazzocchi A, Pelotti P, Serraino S, et al. Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome. Br J Radiol, 2016, 89(1057): 20150407.
9. 王前源, 刘水涛, 卫小春, 等. 体外冲击波疗法治疗肩袖钙化性肌腱炎的荟萃分析. 中国医学前沿杂志 (电子版), 2017, 9(2): 1-6, 173.
10. De Boer FA, Mocking F, Nelissen EM, et al. Ultrasound guided needling vs. radial shockwave therapy in calcific tendinitis of the shoulder: a prospective randomized trial. J Orthop, 2017, 14(4): 466-469.
11. Federico CG, Ramos-Alvarez JJ, Rodríguez-Fabián G, et al. Extracorporeal shockwaves versus ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a randomized controlled trial. Eur J Phys Rehabil Med, 2016, 52(2): 145-151.
12. Kim YS, Lee HJ, Kim YV, et al. Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. J Shoulder Elbow Surg, 2014, 23(11): 1640-1646.
13. de Witte PB, Selten JW, Navas A, et al. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med, 2013, 41(7): 1665-1673.
14. Zhang J, Ebraheim N, Lause GE. Ultrasound-guided injection for the biceps brachii tendinitis: results and experience. Ultrasound Med Biol, 2011, 37(5): 729-733.
15. Zhu J, Jiang Y, Hu Y, et al. Evaluating the long-term effect of ultrasound-guided needle puncture without aspiration on calcifying supraspinatus tendinitis. Adv Ther, 2008, 25(11): 1229-1234.
16. Krasny C, Enenkel M, Aigner N, et al. Ultrasound-guided needling combined with shock-wave therapy for the treatment of calcifying tendonitis of the shoulder. J Bone Joint Surg Br, 2005, 87(4): 501-507.
17. Speed CA, Hazleman BL. Calcific tendinitis of the shoulder. N Engl J Med, 1999, 340(20): 1582-1584.
18. Lanza E, Banfi G, Serafini G, et al. Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting. Eur Radiol, 2015, 25(7): 2176-2183.
19. Niazi G, Hetta W. The role of ultrasound guided percutaneous needle aspiration and lavage (barbotage) in the treatment of calcific tendinitis. J Radiol Nucl Med, 2015, 46(1): 63-70.
20. del Cura JL, Torre I, Zabala R, et al. Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results. AJR Am J Roentgenol, 2007, 189(3): W128-W134.
21. Lin JT, Adler RS, Bracilovic A, et al. Clinical outcomes of ultrasound-guided aspiration and lavage in calcific tendinosis of the shoulder. HSS J, 2007, 3(1): 99-105.
22. Yoo JC, Koh KH, Park WH, et al. The outcome of ultrasound-guided needle decompression and steroid injection in calcific tendinitis. J Shoulder Elbow Surg, 2010, 19(4): 596-600.
23. De Zordo T, Ahmad N, Ødegaard F, et al. US-guided therapy of calcific tendinopathy: clinical and radiological outcome assessment in shoulder and non-shoulder tendons. Ultraschall Med, 2011, 32 Suppl 1: S117-S123.
24. Sconfienza LM, Bandirali M, Serafini G, et al. Rotator cuff calcific tendinitis: does warm saline solution improve the short-term outcome of double-needle US-guided treatment? Radiology, 2012, 262(2): 560-566.
25. Merolla G, Bianchi P, Porcellini G. Ultrasound-guided subacromial injections of sodium hyaluronate for the management of rotator cuff tendinopathy: a prospective comparative study with rehabilitation therapy. Musculoskelet Surg, 2013, 97 Suppl 1: 49-56.
26. Aina R, Cardinal E, Bureau NJ, et al. Calcific shoulder tendinitis: treatment with modified US-guided fine-needle technique. Radiology, 2001, 221(2): 455-461.
27. Sconfienza LM, Randelli F, Sdao S, et al. Septic bursitis after ultrasound-guided percutaneous treatment of rotator cuff calcific tendinopathy. PMR, 2014, 6(8): 746-748.

Chinese Journal of Evidence-Based Medicine

Efficacy of ultrasound-guided percutaneous lavage for rotator cuff calcific tendinopathy: a meta-analysis

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