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

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. 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. 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. 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. aEuro cent US-PICT of rotator cuff is a safe and effective procedure. aEuro cent On average 55 % pain improvement with 10 % minor complication rate. aEuro cent No evidence exists in favour of using a specific size/number of needles. aEuro cent Future need to assess outcome using Constant Score with 1-year minimum follow-up.