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.

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: Fractures of the upper humerus are frequent in elderly persons. While 80% are generally treated orthopaedically, about 20% are complex complicating treatment. Osteosythesis has given disappointing results due to the poor bone quality. Simple humeral arthroplsaty with simple tuberosity fixation could be a solution.

Material and method: Between 1993 and 1998, 50 patients, 39 women and 11 men, mean age 74.5 years (51–90) were treated for cephalotuberosity fractures with cemented humeral arthroplasty. The dominant side was involved in 80% of the cases; there were 39 fractures with four fragments in the Neer classification with seven associated with anterior dislocation, eleven with three fragments including two associated with anterior dislocation. Three patients had a neurological complication: elongation of the brachial plexus in one and irritation of the ulnar nerve in two. Mean delay to surgery was 2.4 days. Thirty-seven patients were operated via the superolateral approach, 13 via the deltopectoral approach. A total of 37 Neer prostheses were implanted and 13 Guepar prostheses. Three patients had a full thickness cuff tear, sutured in the same operative time. The glenoid cavity was healthy in all cases. the upper limb was immobilised elbow against thorax using an abduction brace for 2& days. Active rehabilitation exercises began during the sixth week.

Results: Mean follow-up was 2.5 years. Twelve patients had died, four were lost to follow-up and six could not be examined due to an alteration of their cognitive functions. The analysis thus concerned 28 patients. The mean absolute Constant score at last follow-up was 47 points, with a weighted score of 70 points. Outcome was good in nine cases, fair in eight, and poor in eleven. 86% of the shoulders were pain free. Overall active mobility was: antepulsion 80.5°, abduction 77°, external rotation 20°; 18 patients had internal rotation at L5or more. Radiographically, there was a tuberosity lysis in eight patients and a defective trochiter callus in nine. No changes in the humeral component cementing were observed. The trochiter lever arm was 28 cm, 92.7% of the offset measured on the healthy side. The distance between the apex of the head and the trochiter was 10 mm on the average. Glenoid wear was noted in ten cases. There was no evidence of periprosthetic ossification. Mean ES was 9.9 mm.

Discussion: Pain relief was good. Amplitudes were correlated with age, the quality of the tuberosity fixation, and the duration of rehabilitation (> 1 year). An associated dislocation did not appear to have a deleterious effect. The approach used or offset did not appear to affect results.

Conclusion: Our patients achieved good pain relief but lost a certain degree of mobility, similar to findings reported in the literature. The main prognostic factors are the quality of the tuberosity reconstruction and patient compliance to rehabilitation.