Effet de l'exploration gléno-humérale systématique sur le risque de capsulite rétractile post exérèse arthroscopique de calcifications de la coiffe des rotateurs. Étude rétrospective comparative sur 340 cas

Abstract : Background: Arthroscopic surgery is the reference treatment for rotator cuff calcifying tendonitis refractory to conservative medical treatment (10% of cases). It is common to start excision by systematic exploration of the glenohumeral joint. The most frequent postoperative complication is frozen shoulder, which occurs in 12% of cases. Hypothesis: Glenohumeral joint exploration is a risk factor for frozen shoulder. Methods: This retrospective, continuous, multicentre and multioperator cohort study included 340 patients between 1st January 2012 and 1st January 2018. The following data were collected: epidemiological (age, gender, physical occupation), anamnestic (history of infiltration, trituration), radiological (type and location of calcifications), clinical (preoperative and 6-month Constant score, diagnosis of frozen shoulder – defined by a painful shoulder inflexible in all axes of mobility) and surgical (type of anaesthesia, glenohumeral joint exploration). Results: A total of 251 patients underwent systematic exploration of the glenohumeral joint (LOOKGH group) and 89 patients underwent excision of calcifications without joint exploration (noLOOKGH group). The rate of postoperative frozen shoulder was 2.7-times higher in the LOOKGH group than in the noLOOKGH group: 13.9% vs. 5.6% [95%CI: 1.033-7.18], respectively (p<0.05). Multivariate analysis identified glenohumeral joint exploration as an independent risk factor for frozen shoulder. In patients undergoing glenohumeral joint exploration, only 8.4% of procedures led to the discovery of associated lesions and only 3.6% were curative. Conclusion: Based on these results and those reported in the literature, we don not recommend systematic glenohumeral joint exploration during arthroscopic treatment of rotator cuff calcifications. Level of evidence: III.
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Alexandre Ecalle. Effet de l'exploration gléno-humérale systématique sur le risque de capsulite rétractile post exérèse arthroscopique de calcifications de la coiffe des rotateurs. Étude rétrospective comparative sur 340 cas. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02094372⟩

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