OUTCOME AFTER ARTHROSCOPIC ACROMIOPLASTY FOR CALCIFIED TENOPATHY OF THE ROTATOR CUFF

Abstract

Purpose: Several treatments can be proposed for calcified tenopathy of the rotator cuff. Corticosteroid infiltration, radioscopic trituration-aspiration, and arthroscopy are the most widely used modalities. Over the last decade, we have come to refer our cases of well-circumscribed calcified tenopathy easily accessible to radioscopy to our radiology colleagues since radioscopic treatment has appeared to be quite cost-effective. This trend has continued despite the new interest of the arthroscopists in this disease. We have nevertheless had a certain number of failures (25%) and at this time have decided to prefer arthroscopy. The purpose of this work was to present our results with arthroscopy used after failure of tirturation-aspiration or for patients with calcifications we considered to have contraindications for trituration-aspiration (poorly circumscribed chain of calcifications).

Material and methods: Between 1990 and 1997, we performed 28 arthroscopic procedures in 28 patients. There were 18 women and ten men, mean age 47.5 years (28–71 years). All suffered pain at night and painful blockage during certain motions, particularly anterolateal elevation and forced internal rotation. We did not use the preoperative Constant score because we considered that the pain always gives a false score in these patients, particularly for muscle force. Nevertheless, the mean pain score preoperatively was 4.5 (0–10), daily activity was 14 (8–18) and active motion was 32 (20–40). All calcifications were located in the supraspinatus and the anterior part of the infraspinatus. Acromial morphology was type III in seven cases. All the patients underwent arthroscopy with resection of the coracoacromial ligament and anterior acromioplasty without touching the residual calcification.

Results: All patients were reviewed by an independent surgeon different than the operator. Mean follow-up was 54 months (18–108 months). Subjectively, 89% of the patients were cured or improved, 11% were unchanged. Objectively, the Constant score weighted for age and sex was a mean 91.4% (50–100%) with a median 100%. We had 20 shoulders with excellent outcome (weighted Constant score 85–94%), two with fair outcome (65–84%), and three with poor outcome (< 65%), giving 82% satisfactory outcome. Muscle force was very satisfactory (mean 7.5%) and close to the contralateral shoulder (8.25 kg). Radiologically, 17 of the 29 shoulders were cleared of calcifications (61%).

Conclusion: Arthroscopic acromioplasty after failure of trituration-aspiration gives quite satisfactory results, including for calcifications we had considered to by “untriturables”.