Predicting long-term outcomes of ultrasound-guided percutaneous irrigation of calcific tendinopathy with the use of machine learning.

OBJECTIVE: To evaluate the performance of two machine learning models in predicting the long-term complete pain resolution in patients undergoing ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT). MATERIALS AND METHODS: Within a 3-year period, 100 consecutive patients who underwent US-PICT for rotator cuff disease were prospectively enrolled. The location, maximum diameter, and type of each calcification were recorded. The degree of calcium retrieval was graded as complete or incomplete. Shoulder pain was assessed with the visual analogue scale (VAS) at baseline, 1-week, 1-month, and 1-year post-treatment. Measurements related to procedural details, patient, and calcification characteristics were used to construct a machine learning model for the prediction of pain at 1-year post-US-PICT. Two distinct models were built, one including VAS data at 1 week and another additionally including pain data at 1-month post-treatment. Variable importance analysis was performed for the 1-week model. Model performance was evaluated by using receiver operating characteristics (ROC) curves and the respective areas under the curve (AUC). RESULTS: The model exhibited an AUC of 69.2% for the prediction of complete pain resolution at 1 year. The addition of VAS scores at 1 month did not significantly alter the performance of the algorithm. Age and baseline VAS scores were the most important variables for classification performance. CONCLUSION: The presented machine learning model exhibited an AUC of almost 70% in predicting complete pain resolution at 1 year. Pain data at 1 month do not appear to improve the performance of the algorithm.

Does intraoperative ultrasound help the surgeon in arthroscopic excision of rotator cuff tendon calcifications ?

PURPOSE: Arthroscopic excision of rotator cuff tendon calcifications is a common procedure in cases where medical treatment has failed. The objective of this study was to evaluate how intraoperative ultrasound contributes to improving the interventional procedure. Our hypothesis was that through the use of ultrasonography the frequency of postoperative residual calcium deposits could be reduced without increasing operating time. METHODS: In a non-randomized single-operator comparative study, 56 patients who underwent arthroscopic excision of calcification were retrospectively included: group 1 (n = 20) without ultrasound guidance and group 2 (n = 36) with guidance. Operating time was measured and localization failures noted. Radiological follow-up was carried out with x-ray images at conventional angles and ultrasound at 1.5, 3 and 6 months postoperatively. Clinical follow-up was based on the Constant score (CS) at 6 months. RESULTS: The mean operating time was 18 min in group 1 (9-33 ± 8.1) and 22 min in group 2 (10-48 ± 7.7) (p = 0.03). The rate of failure to identify calcifications was 8% and 2% in groups 1 and 2, respectively (p = 0.22). At 6 months, four calcifications were still visible on radiography in group 1 vs 1 in group 2 (20% vs 2.7%, p = 0.03). The mean CS increased from 35 to 81 points in group 1 (p < 0.001) and from 34 to 82 points in group 2 (p < 0.001). CONCLUSION: Despite an increase in operating time, intraoperative ultrasound improves the process of excising rotator cuff intratendinous calcifications, prevents localization failures and enables a more complete extraction.

Ultrasound-guided percutaneous irrigation of rotator cuff calcific tendinosis. What radiologist should know.

Rotator cuff calcific tendinopathy is a common condition caused by the presence of calcification into the rotator cuff or in the subacromial-subdeltoid bursa. The pathogenetic mechanism of this pathology is still debated. Calcific tendinitis frequently affects the rotator cuff and may cause shoulder pain and reduction of range of motion. It can be diagnosed with conventional radiography, ultrasound, or magnetic resonance imaging. The first therapeutic option includes conservative management based on rest, physical therapy, and oral non-steroid anti-inflammatory administration. Extracorporeal shock wave therapy is a noninvasive technique that can be useful for the fragmentation of calcific deposits. Imaging-guided percutaneous irrigation is currently considered the gold standard technique for the treatment of calcific tendinitis due to its minimal invasiveness and its success rate of about 80%.

US-guided percutaneous irrigation of calcific tendinopathy of the rotator cuff in patients with or without previous external shockwave therapy.

OBJECTIVES: To compare the outcome of US-guided percutaneous irrigation of calcific tendinopathy (US-PICT) of the rotator cuff in patients with or without previous external shockwave therapy (ESWT). METHODS: We analyzed all patients treated with US-PICT from March 1, 2016, to October 1, 2019, with shoulder pain refractory to conservative management for rotator cuff calcific tendinopathy, diagnosed with ultrasound. Each patient was examined using the Constant-Murley Score (CMS) questionnaire (score 0-100) before and after treatment. We tested CMS differences using the Mann-Whitney U (Wilcoxon rank-sum) test in the two groups. US-PICT was performed placing two or multiple 14G needles, according to the calcification size, inserted under US guidance to create a circuit of irrigation in the calcified tendon. NaCl solution at 38 °C was then injected from the entry needle in a variable amount to hydrate and fragment the calcification, finally allowing for its expulsion through the exit needle. All patients also received an intrabursal steroid injection. RESULTS: From 2016 to 2019, 72 US-PICT treatments were performed on 70 patients (females = 46; males = 26) with a mean age of 49.7 years (SD = 8.7. Thirty-three (47%) underwent previous ESWT, while thirty-seven (53%) had no previous treatments. No treatment-related complications were observed. Follow-up was averagely 14.4 months (median = 11.6, SD = 11.9, range 1-45); 37 patients had a follow-up shorter than 12 months (1-11.6); 35 patients were visited after more than 1 year (12.2-45.6, Table W). Before treatment, the mean CMS was 35 (SD = 21); after treatment, it reached 75.4, with an average CMS improvement of 40.3 points (SD = 23.7, p < 0.001). The comparison of improvement between the ESWT and non-ESWT group yielded no significant difference (p = 0.3). CONCLUSIONS: US-PICT of the rotator cuff is an effective procedure to reduce shoulder pain and increase mobility in patients with calcific tendinopathy, both in short- and long-term time intervals. Previous unsuccessful ESWT does not affect the outcome of US-PICT.

Imaging of calcific tendinopathy around the shoulder: usual and unusual presentations and common pitfalls.

Rotator cuff calcific tendinopathy (RCCT) is a very common condition, characterized by calcium deposition over fibrocartilaginous metaplasia of tenocytes, mainly occurring in the supraspinatus tendon. RCCT has a typical imaging presentation: in most cases, calcific deposits appear as a dense opacity around the humeral head on conventional radiography, as hyperechoic foci with or without acoustic shadow at ultrasound and as a signal void at magnetic resonance imaging. However, radiologists have to keep in mind the possible unusual presentations of RCCT and the key imaging features to correctly differentiate RCCT from other RC conditions, such as calcific enthesopathy or RC tears. Other presentations of RCCT to be considered are intrabursal, intraosseous, and intramuscular migration of calcific deposits that may mimic infectious processes or malignancies. While intrabursal and intraosseous migration are quite common, intramuscular migration is an unusual evolution of RCCT. It is important also to know atypical regions affected by calcific tendinopathy as biceps brachii, pectoralis major, and deltoid tendons. Unusual presentations of RCCT may lead to diagnostic challenge and mistakes. The aim of this review is to illustrate the usual and unusual imaging findings of RCCT that radiologists should know to reach the correct diagnosis and to exclude other entities with the purpose of preventing further unnecessary imaging examinations or interventional procedures.

Identification of Differentially Expressed Genes Associated with Extracellular Matrix Degradation and Inflammatory Regulation in Calcific Tendinopathy Using RNA Sequencing.

Calcific tendinopathy (CT), developed due to calcium hydroxyapatite deposition in the rotator cuff tendon, mostly affects women in their 40 s and 50 s and causes severe shoulder pain. However, the molecular basis of its pathogenesis and appropriate treatment methods are largely unknown. In this study, we identified 202 differentially expressed genes (DEGs) between calcific and adjacent normal tendon tissues of rotator cuff using RNA sequencing-based transcriptome analysis. The DEGs were highly enriched in extracellular matrix (ECM) degradation and inflammation-related processes. Further, matrix metalloproteinase 9 (MMP9) and matrix metalloproteinase 13 (MMP13), two of the enzymes associated with ECM degradation, were found to be highly upregulated 25.85- and 19.40-fold, respectively, in the calcific tendon tissues compared to the adjacent normal tendon tissues. Histopathological analyses indicated collagen degradation and macrophage infiltration at the sites of calcific deposit in the rotator cuff tendon. Our study acts as a foundation that may help in better understanding of the pathogenesis associated with CT, and thus in better management of the disease.

Post-surgical Achilles calcific tendinopathy treated with ultrasound-guided percutaneous irrigation.

Calcific tendinopathy typically affects the shoulder rotator cuff tendons. Its management includes shock wave therapy and US-guided percutaneous irrigation, with surgery being less and less used. Extra-shoulder calcific tendinopathy is relatively infrequent and typically affects the hip. While the diagnostic techniques and the treatment options for shoulder calcific tendinopathy have been extensively described, there are only anecdotic reports on the other sites. In this paper, we have reported an unusual case of non-insertional Achilles calcific tendinopathy which occurred many years after Achilles surgical repair. This condition, which presented similar appearance to that of the rotator cuff calcific tendinopathy, is totally different from the well-known and more common insertional calcific Achilles tendinopathy in terms of pathophysiological, imaging, and clinical findings. Further, we have shown that US-guided percutaneous irrigation might be a safe, technically feasible, mini-invasive, and effective treatment also for Achilles calcific tendinopathy.

CALCIFIC TENDINOPATHY: CALCIUM DEPOSIT MORPHOLOGY DIRECTLY AFFECTS PAIN AND FUNCTION OF THE SHOULDER.

The aim of this study was to determine conventional ultrasonography characteristics of calcium deposits in patients diagnosed with calcific tendinopathy, to determine vascularization around deposits by power Doppler, and to compare morphological and power Doppler findings with clinical findings by use of two questionnaires. Pain and function were evaluated using the visual analog scale and two questionnaires, Constant Shoulder Score and Oxford Shoulder Score. All subjects underwent ultrasonography examination and evaluation of vascularization (flow) along calcium deposit using power Doppler. Fifty-one subjects were included in the study. The χ2-test, a non-parametric statistics method was used because of the categorical type of variables. The level of statistical significance was set at p<0.05. In the inactive phase, calcium deposit was shown as a hyperechoic focal point with dorsal acoustic shadow and negative power Doppler finding, whereas in the resorptive phase it appeared as fragmented irregular hyperechoic focal points with positive power Doppler findings. This study showed the patients with fragmented, cloudy calcification to have statistically significantly worse results on functional questionnaires and more positive power Doppler findings (grades II and III) and to experience stronger pain (visual analog scale 8-10). Upon defining the stage of calcific tendinopathy, the method of treatment can be determined and further course of the disease predicted. Defining the stage of calcification precisely helps avoid unnecessary and long-lasting physical therapy while introducing an effective treatment option, depending on the stage of the disease.

Relationship between calcific tendinopathy and rotator cuff tear on shoulder magnetic resonance imaging: case-controlled comparison.

PURPOSE: To determine the frequency of rotator cuff tear on the shoulder magnetic resonance imaging (MRI) of patients with rotator cuff calcific tendinopathy and the relationship between rotator cuff tear and calcific tendinopathy. MATERIAL AND METHODS: In this retrospective case control study, 137 patients with calcific tendinopathy and 137 control group patients without calcific tendinopathy with shoulder pain, whose age, sex, and shoulder laterality values were matched, were compared in terms of rotator cuff tears on their shoulder MRI images. RESULTS: The frequency of rotator cuff tear was found to be significantly higher in the control group (37.2%) compared to the calcific tendinopathy group (23.4%) (p < 0.01). Partial thickness was 81.3% in the calcific tendinopathy group and 70.6% in the control group, and no significant difference was observed between the two groups in terms of the size of the rotator cuff tear (p > 0.05). In the calcific tendinopathy group, there was no significant relationship between the localisation of calcification and the rotator cuff tear, and only in 4.4% of the participants were calcification and tear at the same location on the same tendon (p > 0.05, r = 0.04). CONCLUSIONS: The patients with calcific tendinopathy, who had been admitted with shoulder pain, did not demonstrate an increased risk of rotator cuff tear based on their MRI compared to patients with shoulder pain without calcific tendinopathy. No significant relationship was determined between calcific tendinopathy and rotator cuff tear.

Alternative splicing induces cytoplasmic localization of RBFOX2 protein in calcific tendinopathy.

BACKGROUND: Calcific tendinopathy (CT) is characterized by deposits of calcium, most commonly found in the shoulder tendons. The exact cause and pathogenesis of CT are not fully understood. This study analyzed the expression pattern of RNA-binding protein fox-1 homolog 2 (RBFOX2), a crucial splicing regulator in tissue differentiation. METHODS: Normal and calcific tendons were compared for RBFOX2 mRNA level using quantitative reverse-transcription polymerase chain reaction. Intracellular localization of RBFOX2 protein was investigated using immunofluorescence microscopy. Normal and calcific tendon cDNAs were used to clone RBFOX2. Sequencing analysis identified coding sequences of the RBFOX2 isoform. RESULTS: The intracellular localization of RBFOX2 protein differed with disease status, with RBFOX2 localized in the cytoplasm in calcific tendons and the nucleus in normal tendons. Analysis of the RBFOX2 protein-coding sequence showed that exon 10, responsible for nuclear localization, was absent in calcific tendons. Splicing of RBFOX2 target genes CHD2 and MBNL1 was significantly affected by cytoplasmic localization of RBFOX2 in calcific tendons. DISCUSSION: Given the function of RBFOX2 as a splicing regulator in the nucleus, cytoplasmic localization of RBFOX2 protein in calcific tendons may have affected overall splicing events and altered gene expression. These results provide insights for comprehension of CT pathogenesis.

Ultrasound Appearance of the Migration of Tendon Calcifications.

Calcific tendinopathy (CTe) is a frequent disorder related to the deposition of calcium hydroxyapatite crystals within tendons. Ultrasound has been shown to be an excellent imaging modality for the evaluation of CTe. During the resorptive phase of CTe, calcium deposits may migrate inside the tendons or in neighboring tissues and lead to local inflammation and severe pain. In this pictorial essay, we describe the ultrasound appearance of a spectrum of CTe migrations. Knowledge of the different migration patterns can help sonologists in their detection and in establishing the correct diagnosis.

Incidence of rotator cuff tears in the setting of calcific tendinopathy on MRI: a case controlled comparison.

OBJECTIVE: To compare the incidence of rotator cuff tears on shoulder MRI in patients who have rotator cuff calcific tendinopathy with that in patients without calcific tendinopathy in a frequency-matched case-control study. MATERIALS AND METHODS: Retrospective review shoulder MRIs of 86 patients with rotator cuff calcific tendinopathy and an 86-patient age-, gender-, and laterality-matched control group using frequency matching. RESULTS: No statistically significant difference (odds ratio: 0.72, 95% confidence interval: 0.38-1.38, p = 0.32) was found in the incidence of rotator cuff tear in the calcific tendinopathy (27.9%) and control groups (34.9%). A significant (p < 0.001) difference in the size of rotator cuff tear was seen between the two groups, with 12.5% of tears being full-thickness in the calcific tendinopathy group and 63.3% of tears being full-thickness in the control group. Only 3 of the 24 (12.5%) rotator cuff tears present in the calcific tendinopathy group occurred at the site of tendon calcification. CONCLUSION: Patients presenting with indeterminate shoulder pain and rotator cuff calcific tendinopathy are not at increased risk for having a rotator cuff tear compared with similar demographic patients without calcific tendinopathy presenting with shoulder pain. Calcific tendinopathy and rotator cuff tears likely arise from different pathological processes.

Intraosseous migration of tendinous calcifications: two case reports.

Calcific tendinopathy of the rotator cuff is a common cause of shoulder pain. Inflammation of the rotator cuff tendons may be complicated by adjacent bone erosion and subsequent migration of calcific deposits within the bone resulting in marrow inflammation. Bone marrow involvement is not readily visible using X-ray and ultrasound (US) and further testing is necessary. Magnetic resonance imaging (MRI) is a highly sensitive technique that can detect a focal bone T1 and T2-weighted hypointensity with bone marrow edema-like signal and cortical erosion. These findings can mislead the radiologist by suggesting an infectious or neoplastic lesion, often requiring further evaluation with computed tomography (CT) and biopsy. We report two cases of patients with shoulder pain in which different radiological approaches were used with pathological confirmation in one of them. In the first case, MRI revealed significant bone involvement in the head of the humerus and cortical erosion of the greater tuberosity. A CT examination and a biopsy was necessary for a final diagnosis of inflammatory bone reaction from intraosseous migration of tendinous calcifications. In the second case, similar MRI findings prompted re-evaluation of imaging to make a diagnosis of intraosseous migration of tendinous calcifications, obviating the need to perform CT and biopsy. We illustrate MRI signs of this complication that we think would allow to narrow the differential diagnosis potentially avoiding biopsy and additional CT examinations.

Interventional therapeutic procedures in the musculoskeletal system: an Italian Survey by the Italian College of Musculoskeletal Radiology.

PURPOSE: To perform an online survey among all members of the Italian College of Musculoskeletal Radiology to understand how therapeutic musculoskeletal procedures are performed in daily practice in Italy. METHODS: We administered an online survey to all 2405 members about the use of therapeutic musculoskeletal procedures in their institutions asking 16 different questions. Subgroup analysis was performed between general and orthopaedic hospitals with Mann-Whitney U and χ 2 statistics. RESULTS: A total of 129/2405 answers (5.4% of members) were included in our analysis. A median of 142.5 (25th-75th percentiles: 50-535.5; range 10-5000) therapeutic musculoskeletal procedures per single institution was performed in 2016. Arthropathic pain was the main indication. The most common procedures were joint injection, bursal/tendon injection, and irrigation of calcific tendinopathy. Ultrasound-guided procedures were mainly performed in ultrasonography rooms (77.4%) rather than in dedicated interventional rooms (22.6%). Conversely, fluoroscopic procedures were performed almost with the same frequency in interventional radiology suites (52.4%) and in general radiology rooms (47.6%). In most institutions (72%), autologous blood or components were not used. The median number of therapeutic musculoskeletal procedures performed in orthopaedic hospitals was significantly higher than in general hospitals (P = 0.002), as well as for the use of autologous preparations (P = 0.004). CONCLUSION: Joint injection, bursal/tendon injection, and irrigation of calcific tendinopathy were the most common therapeutic musculoskeletal procedures, being arthropathic pain the main indication. The percentage of procedures and the use of autologous preparations were significantly higher in orthopaedic hospitals than in general hospitals.

Acute calcific tendinopathy of the popliteus tendon: a rare case diagnosed using a multimodality imaging approach and treated conservatively.

Acute calcific tendinopathy of the popliteus tendon is a rare medical entity associated with significant patient discomfort. We present the case of a previously healthy 48-year-old female who presented to the emergency department with acute onset of left knee pain. Initial radiographs revealed calcifications within the posterolateral compartment of the knee. Ultrasound imaging demonstrated a swollen and hypoechoic popliteus tendon with an increased color Doppler signal at the periphery of the tendon as well as calcification in the tendon and adjacent soft tissues. Subsequently performed MRI revealed a thickened and heterogeneous popliteus tendon near its femoral attachment with marked edematous changes surrounding the tendon. Local ultrasound-guided glucocorticoid injection had successful clinical results with no recurrence at 8-month follow-up. In this case report we review the literature for similar previously reported cases. This case report of popliteus tendon calcific tendinopathy provides comprehensive multimodality imaging findings and a description of its non-surgical management.

Calcific tendinopathy of the shoulder with intraosseous extension: outcomes of ultrasound-guided percutaneous irrigation.

OBJECTIVES: Rotator cuff calcific tendinopathy (RCCT) with intraosseous extension is a rare complication of tendinous and peritendinous involvement. The purpose of our study is to evaluate the outcome of ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in patients with intraosseous involvement. MATERIALS AND METHODS: From January 2011 to June 2014, patients with a clinical and imaging diagnosis of RCCT were prospectively categorised in two groups based on imaging findings: group A (10 patients) with intraosseous RCCT and group B (control group 35 patients) without osseous involvement. US-PICT followed by subacromial injection was applied to all patients in groups A and B. During a 1-year follow-up, treatment outcome in terms of pain and functional improvement was evaluated at 3 weeks, 3 months, 6 months, and 1 year, with the use of a four-grade scale. The study has been approved by our hospital's ethics committee. RESULTS: Mean improvement scores of group A were significantly lower than those of group B at all time points (p < 0.0001). Improvement of group B was noted mainly within the first 3 months post-treatment (p = 0.016). CONCLUSION: Outcomes of ultrasound-guided treatment in cases of RCCT with intraosseous extension are significantly less favourable than in purely tendinous or peritendinous disease.

Statin-induced calcific Achilles tendinopathy in rats: comparison of biomechanical and histopathological effects of simvastatin, atorvastatin and rosuvastatin.

PURPOSE: Accumulating clinical evidence indicates the risk of tendinopathy and spontaneous and/or simultaneous tendon ruptures associated with statin use. This experimental study was designed to evaluate and compare the biomechanical and histopathological effects of the three most commonly prescribed statins (simvastatin, atorvastatin and rosuvastatin) on the Achilles tendon in rats. METHODS: Statins were administered by gavage to rats at daily doses of 20 and 40 mg/kg for 3 weeks. One week later, the Achilles tendons were dissected and their biomechanical properties, including ultimate tensile force, yield force and elastic modulus, were determined. The samples were stained with haematoxylin-eosin and examined under a light microscope. The biomechanical properties of the tibia were tested by three-point bending test. Bone mineral density (BMD) and the lengths of tibias were measured by computed tomography. RESULTS: All the statins caused deterioration of the biomechanical parameters of the Achilles tendon. Histopathological analysis demonstrated foci of dystrophic calcification only in the statin-treated groups. However, the number and the total area of calcific deposits were similar between the statin groups. The biomechanical parameters of tibias were improved in all the statin groups. BMD in the statin-treated groups was not significantly different from the control group. CONCLUSION: All the statins tested are associated with calcific tendinopathy risk of which full awareness is required during everyday medical practice. However, statin-associated improvement of bone biomechanical properties is a favourable feature which may add to their beneficial effects in atherosclerotic cardiovascular disease, especially in the elderly.

Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders.

OBJECTIVE: To provide new epidemiological data regarding the prevalence, distribution and macroscopic features of shoulder rotator cuff calcific tendinopathy (calcific tendinopathy), and to identify the characteristics of calcific deposits associated with shoulder pain. MATERIALS AND METHODS: Three hundred and two female volunteers (604 shoulders) who had been referred to a gynaecological clinic participated in the study. The subjects underwent a high-resolution ultrasonography of both shoulders, and those with a diagnosis of calcific tendinopathy compiled a standardized questionnaire relating to shoulder symptoms. We determined the prevalence of symptomatic and asymptomatic rotator cuff calcific tendinopathy, and compared differences in distribution and macroscopic features of the symptomatic and asymptomatic calcifications. RESULTS: The prevalence of calcific tendinopathy was 17.8% (103 shoulders). Ninety-five shoulders (15.7%) were symptomatic; of these, calcific tendinopathy was found in 34 shoulders (33%) on imaging. Of the 509 asymptomatic (84.3%) shoulders, calcific tendinopathy was observed in 69 cases (67%). Among tendons, supraspinatus (53.4%) and infraspinatus (54.6%) were the most frequently involved. The majority of calcific deposits were of maximum diameter between 2 and 5 mm (77.9%), and were linear in form (69.9%). The involvement of multiple tendons and a location in the supraspinatus tendon were found to be significantly correlated with pain (p = 0.023, p = 0.043 respectively), as were age (p = 0.041) and an excessive body mass index (p = 0.024). CONCLUSION: In this sample from the general population of working age females, both intrinsic factors (location in supraspinatus, multiple tendon involvement) and extrinsic variables (age, abnormally high BMI) were correlated with pain in calcific tendinopathy. LEVEL OF EVIDENCE: Level III, cross-sectional study, prevalence study.

Treatment of Calcified Insertional Achilles Tendinopathy by the Posterior Midline Approach.

The present study investigated the clinical outcomes of the posterior midline approach in the treatment of 34 patients with significantly calcified insertional Achilles tendinopathy. The posterior midline approach was applied for the surgical treatment of 34 patients with chronic significantly calcified insertional Achilles tendinopathy after failed conservative treatment. Gastrocnemius recession was performed simultaneously for patients with gastrocnemius contracture. The Fowler-Philip angle and parallel pitch lines were measured before surgery, and the visual analog scale, Tegner score, and Victorian Institute of Sport tendon study group score were recorded before and after surgery. The mean follow-up period was 45.2 ± 17.7 (range 24 to 84) months. After surgery, the visual analog scale score had decreased notably, and the Tegner score and Victorian Institute of Sport tendon study group score had increased significantly. The posterior midline approach can achieve satisfactory outcomes in the treatment of significantly calcified insertional Achilles tendinopathy, and gastrocnemius recession (Strayer procedure) should be performed for patients with gastrocnemius contracture to improve the surgical outcome.

Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients.

BACKGROUND: Calcific tendinopathy is one of the most frequent causes of pain in the shoulder and is characterized by the presence of calcific deposits in the rotator cuff; however, calcific deposits have also been described in asymptomatic individuals. Only a few authors have reported epidemiologic data on the prevalence of calcific deposits in the rotator cuff. METHODS: This study analyzed clinical and radiological data of 1219 adults with and without subacromial pain syndrome (SAPS) to assess the prevalence of calcific deposits in the rotator cuff. Multivariate analysis was used to define risk factors associated with the presence of symptomatic calcific tendinopathy. RESULTS: Calcific deposits were found in the rotator cuff of 57 of 734 asymptomatic patients (7.8%). Of 485 patients with SAPS, 42.5% had calcific deposits. Age between 30 and 60 years (odds ratio [OR], 8.0; 95% confidence interval [CI], 2.5-26.3; P < .001), subacromial pain (OR, 7.1; 95% CI, 5.1-9.9, P < .001), and female gender (OR, 1.5; 95% CI, 1.1-2.0; P = .014) were significantly associated with increased odds of calcific deposits. CONCLUSION: This study demonstrates that women aged between 30 and 60 years with SAPS and a calcific deposit of >1.5 cm in length have the highest chance of suffering from symptomatic calcific tendinopathy of the rotator cuff. The prevalence rates of 7.8% in asymptomatic patients and 42.5% in patients with SAPS provide a current view on the epidemiology of calcific deposits in the rotator cuff.