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Nicola Maffulli - One of the best experts on this subject based on the ideXlab platform.
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modified zadek osteotomy without excision of the intratendinous Calcific Deposit is effective for the surgical treatment of Calcific insertional achilles tendinopathy
Surgeon-journal of The Royal Colleges of Surgeons of Edinburgh and Ireland, 2020Co-Authors: Nicola Maffulli, Nikolaos Gougoulias, Alessio Daddona, Francesco Oliva, Gayle D MaffulliAbstract:Abstract Introduction Nonoperative management of Calcific insertional Achilles tendinopathy (CIAT) may fail in 10–30% of patients, and various operative procedures have been described to manage those. Methods A modified Zadek (dorsal closing wedge) calcaneal osteotomy, without removing the Calcific Deposits and without detaching the insertion of the Achilles tendon, was performed between November 2016 and December 2017 in 25 consecutive patients (mean age 53.5 years), who were followed for at least 2 years. Results The osteotomies had united at an average of 5 weeks. Two superficial wound infections (8%) were documented. Patients had returned to their normal activities at an average time of 23 ± 7.7 weeks. Three out of four patients, who practised recreational sport activity, returned to their pre-injury level. VAS and VISA-A scores had significantly improved at 3 months postoperatively (p Conclusion The modified Zadek osteotomy, without excision of the intra-tendinous Calcification, was safe, and significantly improved clinical outcome in patients with CIAT at 2 years after surgery. Level of evidence IV.
B Nafe - One of the best experts on this subject based on the ideXlab platform.
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shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder
Clinical Orthopaedics and Related Research, 2001Co-Authors: J D Rompe, Jan Zoellner, B NafeAbstract:A prospective quasirandomized study was performed to compare the effects of surgical extirpation (Group I, 29 patients) with the outcome after high-energy extracorporeal shock wave therapy (Group II, 50 patients; 3000 impulses of an energy flux density of 0.6 mJ/mm 2 ) in patients with a chronic calcifying tendinitis in the supraspinatus tendon. Symptoms and demographic data of the two groups were comparable. According to the University of California Los Angeles Rating System, the mean score in Group I was 30 points with 75% good or excellent results after 12 months, and 32 points with 90% good or excellent results after 24 months. Radiologically, there was no Calcific Deposit in 85% of the patients after 1 year. In Group II, the mean score was 28 points with 60% good or excellent results after 12 months, and 29 points with 64% good or excellent results after 2 years. Radiologically, complete elimination of the Deposit was observed in 47% of the patients after 1 year. Clinically, according to the University of California Los Angeles score, there was no significant difference between both groups at 1 year. At 2 years, there was a significantly better result in Group II. Both groups then were subdivided into patients who had a homogenous Deposit as seen on radiographs and patients who had an inhomogenous Deposit before treatment. Surgery was superior compared with high-energy shock wave therapy for patients with homogenous Deposits. For patients with inhomogenous Deposits, high-energy extracorporeal shock wave therapy was equivalent to surgery and should be given priority because of its noninvasiveness.
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bedeutung der kalkdepot elimination bei tendinosis calcarea der schulter
Zeitschrift Fur Orthopadie Und Ihre Grenzgebiete, 2000Co-Authors: J D Rompe, B Nafe, J Zollner, C FreitagAbstract:Aim: To evaluate the effect of complete elimination of the Calcific Deposit on the clinical outcome in patients with a recalcitrant calcifying tendinitis of the shoulder. Patients and methods: 50 patients with a chronic calcifying tendinitis of the shoulder (Type Gartner I or II) underwent a single application of extracorporeal shock waves (3000 impulses, energy flux density 0.60mj/ mm 2 ). After one year 45 patients were evaluated radiologically and clinically. Results: Radiologically a complete absorption of the Calcific Deposit was observed in 21 patients (47%). In 9 patients there was no radiological change. The radiological success was closely related to the radiomorphology of the Deposit. 18 out of 27 good or excellent results were accompanied by a complete disintegration of the Deposit. We calculated a significant dependency between complete disintegration of the Deposit and a good/excellent clinical result (p = 0.0002). Patients with a completely disintegrated Deposit had significantly better scores than those with a partial disintegration of the calcium (p = 0.02), and than those with no radiomorphological changes (p = 0.0003). Spearman's correlation coefficient was 0.6. Conclusion: Elimination of the Deposit is paramount for a good clinical outcome and should be the main goal for any treatment.
Jan K G Louwerens - One of the best experts on this subject based on the ideXlab platform.
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the impact of minimally invasive treatment for rotator cuff Calcific tendinitis on self reported work ability and sick leave
Arthroscopy Sports Medicine and Rehabilitation, 2020Co-Authors: Jan K G Louwerens, Michel P J Van Den Bekerom, Paul P F M Kuijer, Inger N Sierevelt, Barend J Van Royen, Denise Eygendaal, Arthur Van NoortAbstract:Purpose: To examine the impact of rotator cuff Calcific tendinitis on patients' self-reported work ability and sick leave, to compare work ability and sick leave with shoulder function after minimally invasive treatment, and to assess which prognostic factors influence the change in work ability. Methods: A prospective cohort was analyzed in this study. The primary outcome measure was the single-question work ability score (0-10 points). Secondary outcome measures were quality and quantity of work, sick leave, functional outcome, and radiographic resorption. Potential predictive factors (treatment method, age, sex, resorption of the Calcific Deposit, physical work load, and work status) were tested in a statistical model. Follow-up was at 6 months and 1 year. Results: The study cohort consisted of 67 patients. The mean age was 49.6 ± 6.4 years and 45 (67%) were female. Physical workload was categorized as light (58%), medium (24%), and heavy (18%). Work ability score improved from a mean of 6.1 ± 2.8 to 8.5 ± 2.0 points after 1 year. Treatment with minimally invasive treatment techniques was associated with a reduction in partial or full-time sick leave from 28% to 6%. The mean days of sick leave a month declined from 3.3 to 0.8 days. Functional disability was greater in patients with partial or full-time sick leave. The physical workload turned out to be the most important patient associated factor predicting change in work ability. Conclusions: This study supports the hypothesis that rotator cuff Calcific tendinitis has a significant impact on work ability and sick leave. Minimally invasive treatment resulted in a clinically relevant improvement in work ability score and decline in sick leave. In particular, patients with medium and high physically demanding work for the shoulder benefit from minimally invasive treatment to improve their work ability. Level of Evidence: Level II, prospective comparative study.
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comparing ultrasound guided needling combined with a subacromial corticosteroid injection versus high energy extracorporeal shockwave therapy for Calcific tendinitis of the rotator cuff a randomized controlled trial
Arthroscopy, 2020Co-Authors: Jan K G Louwerens, Michel P J Van Den Bekerom, Inger N Sierevelt, Barend J Van Royen, Denise Eygendaal, Erik T Kramer, Rob Boonstra, Arthur Van NoortAbstract:Purpose To compare clinical and radiographic outcomes after treatment with standardized high-energy extracorporeal shock wave therapy (ESWT) and ultrasound-guided needling (UGN) in patients with symptomatic Calcific tendinitis of the rotator cuff who were nonresponsive to conservative treatment. Methods The study was designed as a randomized controlled trial. The ESWT group received ESWT (2000 pulses, energy flux density 0.35 mJ/mm2) in 4 sessions with 1-week intervals. UGN was combined with a corticosteroid ultrasound-guided subacromial bursa injection. Shoulder function was assessed at standardized follow-up intervals (6 weeks and 3, 6, and 12 months) using the Constant Murley Score (CMS), the Disabilities of the Arm, Shoulder, and Hand questionnaire, and visual analog scale for pain and satisfaction. The size, location, and morphology of the Deposits were evaluated on radiographs. The a priori sample size calculation computed that 44 participants randomized in each treatment group was required to achieve a power of 80%. Results Eighty-two patients were treated (56 female, 65%; mean age 52.1 ± 9 years) with a mean baseline CMS of 66.8 ± 12 and mean Calcification size of 15.1 ± 4.7 mm. One patient was lost to follow-up. At 1-year follow-up, the UGN group showed similar results as the ESWT group with regard to the change from baseline CMS (20.9 vs 15.7; P = .23), Disabilities of the Arm, Shoulder, and Hand questionnaire (–20.1 vs –20.7; P = .78), and visual analog scale for pain (–3.9 and –2.6; P = .12). The mean Calcification size decreased by 13 ± 3.9 mm in the UGN group and 6.7 ± 8.2 mm in the ESWT group ( Conclusions This RCT compares the clinical and radiographic results of UGN and high-energy ESWT in the treatment of Calcific tendinitis of the rotator cuff. Both techniques are successful in improving function and pain, with high satisfaction rates after 1-year follow-up. However, UGN is more effective in eliminating the Calcific Deposit, and the amount of additional treatments was greater in the ESWT group. Level of evidence II, randomized controlled trial.
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the effectiveness of high energy extracorporeal shockwave therapy versus ultrasound guided needling versus arthroscopic surgery in the management of chronic Calcific rotator cuff tendinopathy a systematic review
Arthroscopy, 2016Co-Authors: Jan K G Louwerens, Ewout S Veltman, Arthur Van Noort, Michel P J Van Den BekeromAbstract:Purpose The objectives of this comprehensive quantitative review of the treatment of Calcific tendinopathy of the rotator cuff were to investigate if there is a sustainable positive effect on outcomes after treatment with high-energy extracorporeal shockwave therapy (ESWT) or ultrasound (US)–guided needling and to compare these results with those of treatment with arthroscopic surgery. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct this review. A systematic literature search was conducted in December 2014 to identify relevant clinical articles in peer-reviewed journals with at least 6 months' follow-up. Each article was scored using the Coleman Methodology Score. The primary endpoints were functional outcome and radiologic change in the size of the Calcific Deposit. Results Twenty-two studies were included (1,258 shoulders). The mean Coleman Methodology Score for the included studies was 77.1 ± 9.1. Overall, good to excellent clinical outcomes were achieved after treatment with either high-energy ESWT, US-guided needling, or arthroscopic surgery, with an improvement in the Constant-Murley score ranging between 26.3 and 41.5 points after 1 year. No severe side effects or long-term complications were encountered. Conclusions Patients can achieve good to excellent clinical outcomes after high-energy ESWT, US-guided needling, and arthroscopy for Calcific tendinopathy of the shoulder. Side effects and post-treatment complications should be taken into account when a decision is being made for each individual patient. Physicians should consider high-energy ESWT and US-guided needling as minimally invasive treatment options when primary conservative treatment fails. Arthroscopy can safely be used as a very effective but more invasive secondary option, although the extent of Deposit removal and the additional benefit of subacromial decompression remain unclear. Level of Evidence Level IV, systematic review of Level I, II, and IV studies.
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the effectiveness of high energy extracorporeal shockwave therapy versus ultrasound guided needling versus arthroscopic surgery in the management of chronic Calcific rotator cuff tendinopathy a systematic review
Arthroscopy, 2016Co-Authors: Jan K G Louwerens, Ewout S Veltman, Arthur Van Noort, Michel P J Van Den BekeromAbstract:Purpose The objectives of this comprehensive quantitative review of the treatment of Calcific tendinopathy of the rotator cuff were to investigate if there is a sustainable positive effect on outcomes after treatment with high-energy extracorporeal shockwave therapy (ESWT) or ultrasound (US)–guided needling and to compare these results with those of treatment with arthroscopic surgery. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct this review. A systematic literature search was conducted in December 2014 to identify relevant clinical articles in peer-reviewed journals with at least 6 months' follow-up. Each article was scored using the Coleman Methodology Score. The primary endpoints were functional outcome and radiologic change in the size of the Calcific Deposit. Results Twenty-two studies were included (1,258 shoulders). The mean Coleman Methodology Score for the included studies was 77.1 ± 9.1. Overall, good to excellent clinical outcomes were achieved after treatment with either high-energy ESWT, US-guided needling, or arthroscopic surgery, with an improvement in the Constant-Murley score ranging between 26.3 and 41.5 points after 1 year. No severe side effects or long-term complications were encountered. Conclusions Patients can achieve good to excellent clinical outcomes after high-energy ESWT, US-guided needling, and arthroscopy for Calcific tendinopathy of the shoulder. Side effects and post-treatment complications should be taken into account when a decision is being made for each individual patient. Physicians should consider high-energy ESWT and US-guided needling as minimally invasive treatment options when primary conservative treatment fails. Arthroscopy can safely be used as a very effective but more invasive secondary option, although the extent of Deposit removal and the additional benefit of subacromial decompression remain unclear. Level of Evidence Level IV, systematic review of Level I, II, and IV studies.
G Chales - One of the best experts on this subject based on the ideXlab platform.
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high energy extracorporeal shock wave therapy for calcifying tendinitis of the rotator cuff a randomised trial
Journal of Bone and Joint Surgery-british Volume, 2007Co-Authors: Jeandavid Albert, J Meadeb, Pascal Guggenbuhl, F Marin, T Benkalfate, H Thomazeau, G ChalesAbstract:In a prospective randomised trial of calcifying tendinitis of the rotator cuff, we compared the efficacy of dual treatment sessions delivering 2500 extracorporeal shock waves at either high- or low-energy, via an electromagnetic generator under fluoroscopic guidance. Patients were eligible for the study if they had more than a three-month history of calcifying tendinitis of the rotator cuff, with Calcification measuring 10 mm or more in maximum dimension. The primary outcome measure was the change in the Constant and Murley Score. A total of 80 patients were enrolled (40 in each group), and were re-evaluated at a mean of 110 (41 to 255) days after treatment when the increase in Constant and Murley score was significantly greater (t-test, p = 0.026) in the high-energy treatment group than in the low-energy group. The improvement from the baseline level was significant in the high-energy group, with a mean gain of 12.5 (-20.7 to 47.5) points (p < 0.0001). The improvement was not significant in the low-energy group. Total or subtotal resorption of the Calcification occurred in six patients (15%) in the high-energy group and in two patients (5%) in the low-energy group. High-energy shock-wave therapy significantly improves symptoms in refractory calcifying tendinitis of the shoulder after three months of follow-up, but the Calcific Deposit remains unchanged in size in the majority of patients.
J D Rompe - One of the best experts on this subject based on the ideXlab platform.
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shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder
Clinical Orthopaedics and Related Research, 2001Co-Authors: J D Rompe, Jan Zoellner, B NafeAbstract:A prospective quasirandomized study was performed to compare the effects of surgical extirpation (Group I, 29 patients) with the outcome after high-energy extracorporeal shock wave therapy (Group II, 50 patients; 3000 impulses of an energy flux density of 0.6 mJ/mm 2 ) in patients with a chronic calcifying tendinitis in the supraspinatus tendon. Symptoms and demographic data of the two groups were comparable. According to the University of California Los Angeles Rating System, the mean score in Group I was 30 points with 75% good or excellent results after 12 months, and 32 points with 90% good or excellent results after 24 months. Radiologically, there was no Calcific Deposit in 85% of the patients after 1 year. In Group II, the mean score was 28 points with 60% good or excellent results after 12 months, and 29 points with 64% good or excellent results after 2 years. Radiologically, complete elimination of the Deposit was observed in 47% of the patients after 1 year. Clinically, according to the University of California Los Angeles score, there was no significant difference between both groups at 1 year. At 2 years, there was a significantly better result in Group II. Both groups then were subdivided into patients who had a homogenous Deposit as seen on radiographs and patients who had an inhomogenous Deposit before treatment. Surgery was superior compared with high-energy shock wave therapy for patients with homogenous Deposits. For patients with inhomogenous Deposits, high-energy extracorporeal shock wave therapy was equivalent to surgery and should be given priority because of its noninvasiveness.
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bedeutung der kalkdepot elimination bei tendinosis calcarea der schulter
Zeitschrift Fur Orthopadie Und Ihre Grenzgebiete, 2000Co-Authors: J D Rompe, B Nafe, J Zollner, C FreitagAbstract:Aim: To evaluate the effect of complete elimination of the Calcific Deposit on the clinical outcome in patients with a recalcitrant calcifying tendinitis of the shoulder. Patients and methods: 50 patients with a chronic calcifying tendinitis of the shoulder (Type Gartner I or II) underwent a single application of extracorporeal shock waves (3000 impulses, energy flux density 0.60mj/ mm 2 ). After one year 45 patients were evaluated radiologically and clinically. Results: Radiologically a complete absorption of the Calcific Deposit was observed in 21 patients (47%). In 9 patients there was no radiological change. The radiological success was closely related to the radiomorphology of the Deposit. 18 out of 27 good or excellent results were accompanied by a complete disintegration of the Deposit. We calculated a significant dependency between complete disintegration of the Deposit and a good/excellent clinical result (p = 0.0002). Patients with a completely disintegrated Deposit had significantly better scores than those with a partial disintegration of the calcium (p = 0.02), and than those with no radiomorphological changes (p = 0.0003). Spearman's correlation coefficient was 0.6. Conclusion: Elimination of the Deposit is paramount for a good clinical outcome and should be the main goal for any treatment.