Ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a systematic review with meta-analysis of randomized controlled trials

Abstract

Introduction: Ultrasound-guided lavage (UGL) is a minimally invasive percutaneous treatment for rotator cuff calcific tendinopathy (RCCT). It involves the use of a syringe containing saline and/or anesthetic solution injected directly into the calcification allowing aspiration of the fragmented calcific material. The aim of this systematic review is to investigate if UGL is effective in improving pain, function, quality of life, range of motion (ROM), and in promoting complete resorption of calcifications in patients with RCCT.

Evidence acquisition: Only randomized controlled trials considering people diagnosed with RCCT, at any stage and at any time of the onset of symptoms treated with UGL, were included. Embase, CENTRAL, CINHAL, PEDro and MEDLINE were explored up until May 2024. Two independent authors selected randomized controlled trials by title and abstract; afterwards, the full text was thoroughly evaluated. The risk of bias (ROB) was assessed using the Cochrane risk of bias 2 (ROB2) tool and the certainty of evidence was evaluated through the GRADE approach.

Evidence synthesis: Seven studies (709 subjects) were included. Overall, three studies were judged as low risk of bias. Pooled results showed non-significant differences between UGL and extracorporeal shock-wave therapy (ESWT) at 12 weeks (SMD=-0.52, 95% CI -1.57, 0.54, P=0.34, I²=93%) and at 26 weeks (MD=-1.20, 95% CI -2.66, 0.27, P=0.11, I²=82%), while a significant difference favoring UGL (SMD=-0.52, 95% CI -0.85, -0.19, P=0.002, I²=38%) resulted at 52 weeks. In regard to function, pooled results showed non-significant difference between UGL and ESWT at 6 weeks (MD=3.34, 95% CI -11.45, 18.12, P=0.66, I²=79%) and at 52 weeks (SMD=0.10, 95% CI -0.40, 0.60, P=0.69, I²=30%). Considering the rate of resorption of calcifications between UGL combined with subacromial corticosteroid injection (SCI) versus injection alone, pooled results showed significant difference favoring UGL at <52 weeks (RR=1.63 95% CI 1.34, 1.98, P<0.00001, I²=0%). Certainty of evidence ranged from low to very low.

Conclusions: UGL seems to be a reasonable and safe treatment for RCCT, however compared to other non/mini-invasive approaches, UGL showed doubtful results in controlling pain and increasing function and rate of calcifications resorption. These results should be interpreted with caution because certainty of evidence ranged from low to very low.

Figure 1

—PRISMA flow chart.

Figure 2

—Risk of bias graphs: A) traffic light for pain; B) RoB plot for pain; C) traffic light for function; D) RoB plot for function; E) traffic light for rate of resorption; F) ROB plot for rate of resorption; G) traffic light for adverse events; H) ROB plot for adverse events.

Figure 3

—A) Forest plot for pain <12 weeks for ultrasound-guided lavage versus Extracorporeal shockwave therapy; B) forest plot for pain at 26 weeks for ultrasound-guided lavage versus extracorporeal shockwave therapy; C) forest plot for pain at 52 weeks for ultrasound-guided lavage versus extracorporeal shockwave therapy

Figure 4

—A) Forest plot for function at 6 weeks for ultrasound-guided lavage versus extracorporeal shockwave therapy; B) forest plot for function at 52 weeks for ultrasound-guided lavage versus extracorporeal shockwave therapy.

Figure 5

—Forest plot for rate of resorption at <52 weeks for ultrasound-guided lavage versus extracorporeal shockwave therapy.