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.

Purpose of the study: Arthroscopic repair of rotator cuff tendons is a well-described technique. Clinical outcome is good. The purpose of this work was to assess tendon healing as observed with the arthroscan after arthroscopic repair of rotator cuff tears. We search for epidemiological, anatomic, and technical factors predictive of healing.

Material and methods: This was a prospective consecutive non-randomized series of 167 shoulders. All patients were assessed preoperatively with the Constant clinical score and had a standard imaging protocol for assessing the status of the rotator cuff. Arthroscopic repair was used in all cases. Outcome was assessed with the Constant score and an arthroscan was available for 148 patients.

Results: Mean patient age was 59 years, 49% male and 77% dominant side. Mean duration of symptoms before repair was nine months. The tear resulted from trauma in 28% and was a work accident in 9%. The preoperative functional assessment was 52.48. An isolated supraspinatus tear was observed in 68% of the shoulders. Frontal retraction of the supraspinatus was distal in 74%. For 29 shoulders, reduction was difficult and the quality of the tendon was considered normal in 56. Non-anatomic repair was required in six cases. The Constant score at last follow-up (19 months) was 80. An arthroscan was available for 148 shoulders: healing was anatomic in 69, defective healing was observed in 27 and repeated tears were noted in 52. Factors predictive of healing were: demographic (lesion duration less than six months, non-dominant side, young patient, female gender, sedentary lifestyle); anatomic (isolated lesion of the supraspinatus with little extension and no retraction); technical (normal easily reduced tendon, good quality bone).

Discussion: The time before surgical management of rotator cuff tears was an important factor in this study. Tendon and muscle alterations after rotator cuff tears could explain, at least in part, healing failures.

Conclusion: This study confirmed the good functional and anatomic results obtained with arthroscopic repair of rotator cuff tears.

CT arthrography and arthroscopy were used to assess tears of the rotator cuff in 259 shoulders. Tear size was determined in the frontal and sagittal planes according to the classification of the French Arthroscopy Society.

CT arthrography had a sensitivity of 99% and a specificity of 100% for the diagnosis of tears of supraspinatus. For infraspinatus these figures were 97.44% and 99.52%, respectively and, for subscapularis, 64.71% and 98.17%. For lesions of the long head of the biceps, the sensitivity was 45.76% and the specificity was 99.57%.

Our study showed an excellent correlation between CT arthrography and arthroscopy when assessing the extent of a rotator cuff tear. CT arthrography should, therefore, be an indispensable part of pre-operative assessment. It allows determination of whether a tear is reparable (retraction of the tendon and fatty degeneration of the corresponding muscle) and whether this is possible by arthroscopy (degree of tendon retraction and extension to subscapularis).

Purpose: There is no consensus concerning the ideal incongruency of the prosthetic head and the glenoid implant in total shoulder arthroplasty. Certain recent publications suggest the rate of periglenoid lucency is lower if the incongruency is greater than 5.5 mm. The purpose of this experimental in vitro work was to study the influence of changing humeral head-glenoid congruency on periglenoid bony malformations of prosthesis-bearing cadaveric scapulae and on the motion of the glenoid implants.

Material and methods: Five scapulae from subjects aged 76 to 91 years at death were harvested and implanted with five stem cemented glenoid implants with an identical curvature. Five metallic balls with different radii were used to simulate incongruency of the humeral head-glenoid implant varying from 0 (perfect congruency) to 6 mm (0.2, 4.5, and 6 mm). The protocol involved preloading at 400 N following a normal axis for the glenoid implant and then posteroanterior translation and inferosuperior translation of 2.5 mm. The force necessary to impose the translation displacement, periglenoid bony deformations, and implant displacement compared with the bony glenoid were measured with a traction-compression device using deformation gauges and two CCD cameras in compliance with a published protocol.

Results: Increasing incongruency decreased the force necessary to displace the metallic balls, decreased periglenoid bony deformations around the loaded zones and decreased the degree of prosthetic displacement facing the loaded zone.

Discussion: The limitations of this experimentation are the small number of implants tested and the subsequent lack of statistical analysis concerning the reality of the differences observed. Besides, the experimental protocol cannot reproduce the normal conditions of the prosthesis articulation. Nevertheless, these results appear to favour the idea of greater bone and prosthetic tolerance with lesser humeral head-glenoid implant congruency. This might provide an explanation for the fewer glenoid lucent lines found in vivo in similar congruency situations.

Conclusion: These results suggest that a certain degree of incongruency of total shoulder prostheses could reduce the risk of periprosthetic lucency. Ideal incongruency remains to be determined with further in vitro and in vivo studies.