and I was a fellow in Pittsburgh last year. So we'll talk about predictive factors of failure of conservative management and the treatment of the calcific tendinitis of the shoulder. I'd like to thank my co-authors. No disclosures related to this project. So calcific tendinitis of the shoulder is a painful condition characterized by the calcium deposits within the rotator cuff. When conservative management fails, arthroscopic surgery for removal of calcium may be considered. And the surgical removal is often followed by a rotator cuff repair to address the resulting tendon defect. So these studies was performed to assess predictive factors for failure of conservative management and also to characterize the rate of rotator cuff repair in the setting of surgical intervention for calcific tendinitis. So we hypothesized that the large deposit site and decreased range of motion lower self-report, patient report outcomes would be predictive of failure of conservative management. This was a retrospective review of consecutive patients who were diagnosed with calcific tendinitis in our institution from 2009 to 2019. So demographics, comorbidities, pain score, ASCS score, range of motion, and PROMIS score were recorded and analyzed. All patients had a radiograph and MRI done. And the size of calcific lesion were measured by the MRI to avoid magnification error to the X-ray. So all patient initially underwent conservative management with option physical therapy, glucocorticoid injection, uterine-torsone aspiration, or a combination of each. And we divide the cohort based on the response of the no-op treatment. So the patients who were successfully treated no-op was the group one. And the patient who failed no-operative treatment and undergoing surgery would make the number two, group two. So regarding the surgical technique, a complete removal of the calcium depositor was done arthroscopically. And after the removal, the tendon defect were analyzed. And then if the defect was a high-grade tear or a full-thickness tear, the defect were repaired. And statistical analysis were done. So we were able to collect 235 patients, 53% female, average age is 54. So majority of the cases, rotator cuff was intact. The location, when you look at isolated tendon, so predominantly it was supraspinatus, followed by infraspinatus, subscap, and teres minor. There's a, when they are 28%, has a combined location as well. So majority of the patient, they improve with no-operative treatment, but a reasonable subset of patients in our cohort, like 93 patients representing 38.9% failed conservative treatment. When you look at the failure rate in the specific modality of no-operative treatment, they were not statistical different. When you look at the concomitant procedure, 82% ended up having a rotator cuff repair after the calcium removal. This was impressive. And when you look at the pain and the ASCS score and the range of motion, all of them improved significantly from preoperative and postoperative. So when you look at our results, we did a comparison between the no-operative group and the operative group to try to find any predictive factors. And the only predictive factor for failure that we found was that calcific lesions greater than one centimeter was predicted for failure. And the odds ratio was 2.86. Decreased range of motion in low self-report, patient-report outcomes were not predicted as we hypothesized. Actually, we found the opposite. And one explanation that we could find about it, maybe those patients with more motion and more patient-report outcomes, they have like a higher expectation, they are more active, so that's one of the reasons they fail. So all the others variables were not statistically different between groups. So regarding limitations of our study, we didn't have a patient-report outcomes for the patients who successfully underwent conservative treatment because usually we only take a patient-report out when the patient goes to surgery. So this prevent us to do a comparison regarding clinical outcomes between the no-op and operative group. And even though the patients, they improved significantly in six months, as you could see in the table, this is a relatively short-term follow-up. So our take-home message for this study is that first, that the no-operative treatment is successful in the majority of the cases of calcific tendinitis of the shoulder. Patients with calcific lesions greater than one centimeter has 2.8 increased likelihood to undergo operative treatment in the setting of the calcific tendinitis of the shoulder. In most of the patients who undergo surgical management for removal of the calcific deposit, they require rotator cuff repair, and they had significant improvements in shoulder pain and function. So we think that this information can be helpful in guiding the patients when you have the conversation when indicating surgery for this particular population, especially regarding the rehabilitation protocol once you have to repair the rotator cuff. There's a totally different protocol, so thank you very much. Thank you.

calcific tendinitis

conservative management

surgical intervention

rotator cuff repair

non-operative treatment