Arthroscopic repair of the rotator cuff: Prospective study of tendon healing after 70 years of age in 145 patients

Abstract

Arthroscopic repair significantly improves the clinical results, even in patients older than 70 years. The clinical results are not correlated with age (but deterioration of the result was not noted after 75 years) or frontal retraction (but the study only included retractions limited to stages 1 and 2). The healing rate is satisfactory, but this study is limited to small ruptures of the supraspinatus, and the postoperative ultrasound analysis probably inferior to CT imaging with contrast agent injection, often used as the reference. Healing proves to be correlated with the quality of the clinical result and patient age.

Expectations Following Rotator Cuff Surgery

“…Arthroscopic rotator cuff repair is an effective, minimally invasive surgical procedure that can decrease pain and increase function allowing patients to improve their quality of life [28][29][30]. Factors that affect results following rotator cuff repairs include tendon quality, fatty infiltration, tear size and retraction, chronicity of the tear, age of the patient, smoking status, diabetes, concomitant pathology, and patients with hyperlipidemia and high white blood cell count (WBC).…”

Surgical Treatment of Rotator Cuff Tears After 65 Years of Age: A Systematic Review

“…In the study by Lam et al, 40 the purpose was to evaluate functional outcome and identify possible preoperative prognostic factors in patients aged 65 years or more, undergoing repair for a massive (> 5 cm) full-thickness rotator cuff tear. Miyazaki et al 35 33,34 were multicenter prospective studies conducted in 11 surgical centers and presented in the Société Française d'Arthroscopie (French Arthroscopic Society, SFA) symposium in 2012. Both studies had similar population groups, but set different objectives.…”

“…Both studies had similar population groups, but set different objectives. The first study 33 proposed to answer the questions of whether repair of supraspinatus lesions in patients older than 70 years of age is reliable in terms of both clinical results and healing, and whether tendon healing is significantly correlated with the CSS, ASES and SST scores as well as with age, tendon retraction and fatty infiltration. The second study 34 hypothesized that arthroscopic repair would be superior to decompression in patients with 70 years of age and above, comparing clinical results with each technique as well as analyzing the effects of age, tendon retraction and fatty infiltration on the outcome (paraclinical data in this study was extremely thorough).…”

“…Some studies excluded massive tears (> 5 cm). 33,34,37 Multiple tendon lesions were included in all studies under specific limitations. 32,39,41,44 Verma et al 19 excluded RCT with subscapularis involvement (100% had supraspinatus and 38.5% had infraspinatus involvement).…”

“…32,39,41,44 Verma et al 19 excluded RCT with subscapularis involvement (100% had supraspinatus and 38.5% had infraspinatus involvement). Some studies set criteria for tendon reparability including acromio-humeral distance, 33,39 tendon retraction according to Patte (< 3) 34 and fatty infiltration according to Goutallier (G < 3) 32,39,41 (G < 4). 33,34 Non-reducible tears without tension or requiring intraoperative arthrolysis were excluded in both level II studies.…”