Septuagenarians aged 75 years and older do benefit from arthroscopic rotator cuff repair: a propensity matched-pair analysis

Abstract

Background Numerous studies show that patients who failed conservative management, benefit from open, mini open and arthroscopic rotator cuff repair (ARCR). However, there is a paucity of literature addressing ARCR and outcomes in patients older than the age of 75 years. The purpose of our study was to compare the outcomes of ARCR in patients older than 75 years and younger than 75 years of age. Methods Between January 2010 and December 2016, 397 patients underwent unilateral ARCR; of which, 23 patients were 75 years of age and older. Outcome measures recorded include the Constant Shoulder Score (CSS), University of California, Los Angeles Shoulder Score (UCLASS), Oxford Shoulder Score (OSS), and visual analog scale (VAS) for pain assessment. Results There were no statistically significant differences in VAS, CSS, and UCLASS between the two groups at all time points of follow-up (all P > .05). At 2 years after surgery, the OSS was 2 ± 5 points better in the <75 group ( P = .012). However, the improvement in OSS was comparable between both groups. The improvement in VAS, CSS, and UCLASS at 2 years after surgery compared with baseline was also similar between the two groups (all P < .05). Conclusions The improvement in VAS, CSS, and UCLASS was similar in both groups of patients. We conclude that septuagenarians with symptomatic cuff tears, who have failed conservative management, experience significant improvement in pain, and function after surgery and should not be excluded from the benefits of ARCR.

Repair of rotator cuff tears in patients aged 75 years and older: Does it make sense? A systematic review

“…We found in this systematic review that patients older than 75 years could achieve good outcomes (11)(12)(13)(14)(15)(16). Their postoperative scores were significantly higher than the preoperative scores.…”

“…Ten were excluded because they were review articles. Through a comprehensive review of the remaining articles and their citations, with a detailed search of the literature, six studies (11)(12)(13)(14)(15)(16) were ultimately included in the current systematic review (Figure 1).…”

“…Five studies (282 shoulders) reported the tear size: 5 small, 27 medium, 75 small / medium, 94 large, 81 massive tears, and the rest were unspecified (12)(13)(14)(15)(16). Four studies (11)(12)(13)(14)) used an arthroscopic approach; one study ( 16) used an open approach; one study (15) used both approaches. Among surgical repair techniques, 56 cases underwent single-row repair, 87 underwent double-row repair, and the remaining cases were treated by other methods.…”

“…Several studies have documented better postoperative functional gain and structural healing of the rotator cuff. Achieving good tendon healing could reasonably be considered one of the primary objectives of the surgery (11)(12)(13)(14)(15)(16). Due to the large number of comorbidities observed in the elderly population and the complications and high rates of recurrent tears seen after RCR surgeries, experts have debated whether surgery was an effective treatment for rotator cuff lesions in this population.…”

“…Based on several small case series reporting successful clinical outcomes in patients older than 75 years after repair surgery (11)(12)(13)(14)(15)(16), this systematic review aimed to pool these findings and evaluate the clinical outcomes of RCR in patients aged ≥75 years. In doing so, we aim to found that whether surgical treatment was beneficial for structural tendon healing with good clinical outcomes following rotator cuff injuries in this advanced age group, making it the preferred treatment option.…”