ROTATORCUFF-REPAIR IN PATIENTS YOUNGER AND OLDER THAN 60 YEARS, MID-TERM RESULTS AFTER 16 MONTHS AND 3.5 YEARS.

Abstract

The purpose of this study was to evaluate if there was a difference in the outcome of operative treatment for rotator cuff-tears in patients younger and older than the age of 60.

Thirty-eight patients (19 male, 19 female) underwent 40 procedures and were postoperatively evaluated 15 and 42 months after surgery. At the time of follow-up they had a physical examination that included the Constant score, radiograph in three planes and a questionnaire focused on the need for analgesics, nocturnal pain, and return to full activity (work and sports). Cuff tears were classified by the Harryman classification. Corresponding to the study design, patients were divided into two age groups: under the age of sixty years (51a, min. 44a, max. 58a, n=22) and patients sixty years of age and older (68,3a, min. 60a, max. 82a, n=16).

Active range of motion increased significantly in both age groups (p< 0.05) from 101° to 152° in abduction after the first 15 months after surgery and in anteversion from 117° to 155°. By the time of the second evaluation, abduction had decreased to 136° for abduction and 149° for anteversion. The results of functional assessment by the Constant score was 72 points after 16 months and after 42 months decreasing to 62 points in the group of patients under the age of 60, and from 71 to 66 points in the group of patients 60 years of age and older.

In both age groups there was a continuous increase in muscle force: from 4.35kp after 15 months to 4.5kp after 42 months in patients younger than 60, and from 2.24kp to 3.75kp in the older age group. Pain and the use of analgesic medication decreased significantly (p< 0.0001 and p=0.0003) in both age groups during the first 15 months after surgery and after 42 months had remained at the same low level. There was a correlation between extent of the cuff tear and results of functional assessment by the constant score. For patients with Harryman Type I cuff tears, mean score after 15 months was 78 points decreasing to a mean score of 65 points after 42 months. Harryman Type II cuff tears decreased from 74 to 70 points, with Type III cuff tears decreasing from 63 to 57 points.

Patients in the age group of 60 years and older had more similar benefits from operative treatment for rotator cuff-tears than the group under the age of 60. The best clinical result in both groups appeared during the first two years after surgery and decreased an average of 3.5 years postoperatively. The results of the Constant Score were influenced primarily by the size of the cuff tear.