Is ultrasound-guided lavage an effective intervention for rotator cuff calcific tendinopathy? A systematic review with a meta-analysis of randomised controlled trials

Simon Lafrance, Patrick Doiron-Cadrin, Marie Saulnier, Martin Lamontagne, Nathalie J Bureau, Joseph-Omer Dyer, Jean-Sébastien Roy, François Desmeules, Simon Lafrance, Patrick Doiron-Cadrin, Marie Saulnier, Martin Lamontagne, Nathalie J Bureau, Joseph-Omer Dyer, Jean-Sébastien Roy, François Desmeules

Abstract

Background: Rotator cuff calcific tendinopathy is characterised by the deposition of hydroxyapatite crystals in one of the rotator cuff tendons and can be managed by ultrasound-guided lavage. However, evidence regarding the efficacy of ultrasound-guided lavage for rotator cuff calcific tendinopathy remains inconclusive. The aim of this systematic review and meta-analysis is to update the available evidence on the efficacy of ultrasound-guided lavage in adults with rotator cuff calcific tendinopathy.

Methods: A literature search was conducted up to April 2018 in four bibliographic databases to identify randomised control trials that compared ultrasound-guided lavage alone with other interventions to treat rotator cuff calcific tendinopathy. Randomised control trials were assessed with the Cochrane Risk of Bias Tool. Meta-analyses and/or qualitative synthesis of the evidence were performed.

Results: Three randomised control trials were included. Pooled results for pain (n=226) indicated that ultrasound-guided lavage may significantly decrease pain when compared with shockwave therapy, with a mean difference of -1.98 out of 10 points (95% CI -2.52 to -1.45) in the short term and of -1.84 (95% CI -2.63 to -1.04) in the long term. Based on one trial (n=25), ultrasound-guided lavage significantly improved function when compared with shockwave therapy (p<0.05). Based on another trial (n=48), the addition of ultrasound-guided lavage to a corticosteroid injection significantly improves function in the long term (p<0.05).

Conclusion: For individuals with rotator cuff calcific tendinopathy, low-quality evidence suggests that ultrasound-guided lavage is more effective than shockwave therapy or a corticosteroid injection alone. Future trials could modify the present conclusions.

Trial registration number: CRD42018095858.

Keywords: hydroxyapatites and needling; rotator cuff; shoulder; tendinopathy.

Conflict of interest statement

Competing interests: All authors except NJB report grants from Institut de recherche Robert-Sauvé en santé et sécurité au travail (IRSST) during the conduct of the study which may be considered as a potential conflict of interest. However, since the IRSST is not a private company and does not have any financial interest in the treatment of shoulder disorders, this grant should not be considered as a conflict of interest. We still decided to declare this grant as a potential conflict of interest.

Figures

Figure 1
Figure 1
Schematic breakdown of literature search results. RCT, randomised controlled trial.
Figure 2
Figure 2
Detailed methodological assessment of included studies using the Cochrane risk-of-bias tool. Green: low risk of bias, red: high risk of bias, yellow: unclear or unknown risk of bias.
Figure 3
Figure 3
Risk-of-bias graph: review authors’ judgements about each risk-of-bias item, presented as percentages across all included studies.
Figure 4
Figure 4
Forest plots of pooled studies ultrasound-guided lavage with a corticosteroid injection to shockwave therapy for change in pain in patient with chronic rotator cuff calcific tendinopathy. The squares are mean differences and the diamonds are pooled mean difference with 95% CIs. UGL, ultrasound-guided lavage.

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