Prognostic factors for outcomes following needling and shockwave therapy in rotator cuff calcific tendinitis: A systematic review.

Background: This systematic review aimed to evaluate prognostic factors associated with outcomes following needling and shockwave therapy (SWT) for RCCT rotator cuff calcific tendinitis (RCCT). Methods: MEDLINE, EMBASE, and CENTRAL databases were searched for studies on prognostic factors in RCCT treated with needling or SWT that included multivariable analyses. The risk of bias was assessed using the Quality in Prognosis Studies tool, and the quality of each prognostic factor was evaluated using a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results: 13 studies involving 1693 shoulder patients were included, of which 11 evaluated needling and two evaluated SWT, all showing moderate-to-high risk of bias. Across needling studies, 32 variables were evaluated in multivariable models, with five showing potential predictive value for treatment success based on GRADE quality: larger calcification size, Type III Gartner-Heyer (fluid-like) classification, shorter distance between the subacromial bursa and deposit, normal bursal appearance, and fewer needling sessions. In SWT studies, four variables were analysed, with Type III calcifications and shorter symptom duration associated with better outcomes. Discussion: Certain disease- and procedural-related factors may predict better outcomes with needling or SWT for RCCT, though the evidence is limited and requires prospective validation to refine patient selection. Level of Evidence: III.