ARTHROSCOPIC REPAIR OF FULLTHICKNESS ROTATOR CUFF TEARS: IS THERE A TENDON HEALING IN PATIENTS OLDER THAN 65 YEARS?

Abstract

Purpose of the study: Surgical treatment of rotator cuff tears (RCT) in the older subject is genearlly considered to best involve simple debridement without any attempt at repair. This is however no evidence concerning the healing capacity of tendon repairs after RCT in the older subject. The purpose of this study was to assess the functional outcome of arthroscopically repaired RCT in subjects aged over 65 and to determine the healing pattern.

Materials and Methods: This was a non-randomized prospective study which included patients aged over 65 years who presented a full thickness RCT repaired arthroscopically. The patients were evaluated preoperatively and at last follow-up with the simple shoulder test (SST) and the Constant score. A control arthroscan was obtained systematically six months postoperatively.

Results: From January 2001 through December 2004, 88 patients, mean age 70 years were included in this study with a mean follow-up of three years (range 2–5 years). The tear involved two tendons in 45 shoulders, the frontal retraction was distal in 58 shoulders, the index of fatty degeneration was 0.6 (range 0–3) preoperatively and 13 patients presented stage 1 chondral lesions. The SST improved from 2.4 (range 1–6) preoperatively to 9.7 (3–12) at last follow-up (p< 0.001) and the Constant score from 45 (10–70) to 77.7 (49–93) (p< 0.001) Seventy-seven patients (87.5%) had a control arthroscan and 45 had an intact cuff. For the patients with an intact cuff, the SST was 10.6 and the Constant score 81.6 versus respectively 7.8 and 72.1 for patients with a non intact cuff (p< 0.001). Factors predictive of non healing were size of the tear (p=0.02), its frontal extension (p=0.01), its tendinous aspect (p=0.02) and difficult reduction (p=0.005). There was no increase in the size of the tears (p=0.46). Six patients presented Hamada stage 1 osteoarthritis at last follow-up.

Discussion: This study is the first to demonstrate objective evidence of tendon healing after arthroscopic repair of RCT in patients aged over 65 years. In 59% of the patients, the arthroscan demonstrated intact cuffs with a significant improvement in the functional results.

Conclusion: Arthroscopic repair of RCT in subjects aged over 65 years provides satisfactory results and can be proposed as treatment.