Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting

Objectives: We performed a systematic review of current evidence regarding ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in the shoulder aimed to: assess different published techniques; evaluate clinical outcome in a large combined cohort; and propose suggestions for homogeneous future reporting. Methods: Cochrane Collaboration for Systematic Reviews of Interventions Guidelines were followed. We searched MEDLINE/MEDLINE In-Process/EMBASE/Cochrane databases from 1992–2013 using the keywords ‘ultrasound, shoulder, needling, calcification, lavage, rotator cuff’ combined in appropriate algorithms. References of resulting papers were also screened. Risk of bias was assessed with a modified Newcastle-Ottawa Scale. Results: Of 284 papers found, 15 were included, treating 1,450 shoulders in 1,403 patients (females, n = 838; mean age interval 40–63 years). There was no exclusion due to risk of bias. Conclusions: US-PICT of rotator cuff is a safe and effective procedure, with an estimated average 55 % pain improvement at an average of 11 months, with a 10 % minor complication rate. No evidence exists in favour of using a specific size/number of needles. Imaging follow-up should not be used routinely. Future studies should aim at structural uniformity, including the use of the Constant Score to assess outcomes and 1-year minimum follow-up. Alternatives to steroid injections should also be explored. Key Points: • US-PICT of rotator cuff is a safe and effective procedure. • On average 55 % pain improvement with 10 % minor complication rate. • No evidence exists in favour of using a specific size/number of needles. • Future need to assess outcome using Constant Score with 1-year minimum follow-up.