Rotator Cuff Repair In The Elderly: Is It Worthwhile?

Clin Orthop Surg. 2022 Dec; 8(iv): 420–427.

Rotator Cuff Repair in Patients over 75 Years of Historic period: Clinical Outcome and Repair Integrity

Jung Gwan Park, MD, Nam Su Cho, MD, Jong Hoon Song, Physician, Jong Hun Baek, MD, Ho Yeon Jeong, MD, and Yong Daughter Rhee, Dr.

Jung Gwan Park

Shoulder & Elbow Clinic, Section of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea.

Nam Su Cho

Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea.

Jong Hoon Song

Shoulder & Elbow Dispensary, Section of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea.

Jong Hun Baek

Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee Academy School of Medicine, Seoul, Korea.

Ho Yeon Jeong

Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University Schoolhouse of Medicine, Seoul, Korea.

Yong Girl Rhee

Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee Academy School of Medicine, Seoul, Korea.

Received 2022 Mar 16; Accepted 2022 October 13.

Abstract

Background

Some studies have shown significant functional improvement afterwards rotator cuff (RC) repair in elderly patients. However, few studies have reported the healing potential of RC tears in elderly patients.

Methods

Twenty-five patients aged ≥ 75 years who underwent RC repair were enrolled. The hateful age at the fourth dimension of surgery was 78.3 years (range, 75 to 88 years) while the mean follow-upward was 36.3 months (range, xviii to 114 months). We evaluated clinical and structural outcomes subsequently RC repair in the retear and healed groups.

Results

Of 25 patients, 16 (64%) had healed RC lesions and 9 (36%) had retorn cuff lesions. The retear charge per unit increased significantly with increasing initial tear size (small to medium, 13%; large, threescore%; massive, eighty%; p = 0.024) but not with increasing historic period (p = 0.072). The mean visual analog scale (VAS), University of California Los Angeles (UCLA), and Constant scores significantly improved from 5.2, xv.8, and 49.3 preoperatively to 1.4, 31.1, and 71.ix in the healed group and from 6.0, 14.4, and 39.5 preoperatively to 2.4, 28.iii, and 63.6 in the retear group at the final follow-upwardly (p < 0.05, respectively). At that place were no significant differences in clinical outcomes betwixt the ii groups at the final follow-up. Retear was significantly correlated with initial tear size (p = 0.001; odds ratio [OR], 2.771; 95% conviction interval [CI], 1.394 to 5.509 for large to massive tears) (p = 0.001; OR, 0.183; 95% CI, 0.048 to 0.692 for modest to medium tears).

Conclusions

There were significant improvements in clinical outcomes after RC repair in patients ≥ 75 years. Structural integrity after gage repair did non impact the concluding clinical outcome. Even in elderly patients aged ≥ 75 years, healing of repaired RC can exist expected in cases of small to medium tears. Although the retear rate was relatively high for large to massive tears, clinical outcomes still showed significant improvement.

Keywords: Shoulder, Rotator cuff, Aged, Treatment outcome

The incidence of rotator cuff tears (RCT) increases with age and tends to occur every bit part of the degenerative process of crumbling.¹ ^,2) Studies have reported the prevalence of full-thickness RCT of 28% in patients ≥ 60 years former, 50% in those ≥ 70 years, and lxxx% in those ≥ lxxx years.³ ^,4 ^,5) Fifty percent of asymptomatic RCT go symptomatic at a mean of 2.8 years afterwards diagnosis.^half-dozen) Furthermore, untreated RCT size may increase over fourth dimension with subsequent tendon retraction and irreversible muscle atrophy.⁷ ^,viii)

The incidence of RCT increases with age, merely the effectiveness and healing potential of cuff repair in elderly patients remains controversial for several reasons. Elderly patients are more likely to take osteoporosis of the greater tuberosity, which may significantly complicate suture anchor fixation, resulting in reduced cellular action and poorer potential for healing.^iv) Those anile ≥ 65 years have a larger tear size, which is associated with greater tendon degeneration and potentially increased repair difficulty.ⁱ⁾ Elderly patients frequently take comorbidities that may weaken the healing response and complicate surgical management.⁹⁾ They also tend to take more than medical problems and shoulder dysfunction, which are associated with a compromise in an private's wellness status similar to that seen in major medical diseases such as congestive centre failure, acute myocardial infarction, and diabetes mellitus.¹⁰⁾ These factors tin have a negative influence on the healing procedure of the repaired tendon. Studies accept clearly demonstrated that rotator cuff healing failure leads to poorer functional outcome, particularly strength, besides as a decrease in the healing rate related to avant-garde age and greater rotator gage degeneration.³ ^,11 ^,12 ^,13)

In contrast, successful rotator cuff repair in elderly patients with RCT have been reported.¹⁴⁾ Grondel et al.¹⁴⁾ reported the effectiveness of rotator gage repair in an older population, with good or first-class results in 84 of 97 shoulders (87%). Their results indicated that elderly patients continued to improve in function and strength for > 12 months after RC repair with decreased activity and the age of the patient did not appear to exist a contributing factor to a successful result. In addition, some elderly patients with RCT desire to remain physically active with high functional demands. Surgeons often consider surgical repair for these patients when astringent persistent pain and disability of the shoulder is nonresponsive to bourgeois treatment. However, a limited number of studies take reported the healing potential of repaired RCT in elderly patients.

The purpose of this written report was to evaluate the clinical and structural outcomes of elderly patients aged ≥ 75 years who underwent arthroscopic or open repair of a full-thickness RCT and make up one's mind the factors associated with clinical effect and retear. Nosotros hypothesized that rotator gage repair in elderly patients ≥ 75 years would show inferior clinical outcomes due to the depression healing potential and high retear charge per unit of repaired rotator cuff lesions in this historic period group.

METHODS

This study was retrospective in nature. The Kyung Hee University Medical Heart Institutional Review Board canonical the report and informed consent requirement was waived (KMC IRB 1508–08).

Patient Selection

From March 2003 to July 2022, 59 consecutive patients aged ≥ 75 years underwent arthroscopic or open rotator cuff repair for the treatment of full-thickness RCT that were diagnosed primarily by physical exam and preoperative magnetic resonance imaging (MRI) and confirmed by arthroscopic findings. RCT sizes were measured intraoperatively according to the classification of DeOrio and Cofield¹⁵⁾ by assessing the anteroposterior dimension with the use of a calibrated probe introduced through the posterior portal with a view from the lateral portal. The tear sizes were categorized into small (< 1 cm), medium (1–3 cm), big (iii–v cm), and massive (> 5 cm). Patients who had acromioclavicular arthritis that required distal clavicle resection, advanced glenohumeral arthritis, RCT with a Workers' Compensation claim, incomplete medical tape, or no postoperative follow-up MRI at least 12 months later on surgery were excluded from the study. Patients undergoing revision procedures were also excluded. A total of 25 patients (4 male person, 21 female mean age at surgery, 78.3 years [range, 75 to 88 years]; mean follow-up, 36.3 months [range, xviii to 114 months]) who were bachelor for postoperative MRI evaluation at least 12 months after rotator cuff repair were enrolled in this report.

Patients were considered surgical candidates if they had persistent shoulder hurting that was unresponsive to at to the lowest degree half dozen months of adequate conservative treatments such as anti-inflammatory medication, physical therapy, subacromial corticosteroid injection, and activeness modification. Arthroscopic repair was performed when the tears could be repaired without undue tension based on arthroscopic findings. A double-row repair with a suture-bridge technique was used for medium to large tears, while a single-row repair was used for small tears and for massive tears that could exist repaired with full coverage of the footprint. Open repair was indicated when: (ane) a tear was arthroscopically irreparable because of astringent retraction of the tendon; (2) tendon tissue quality was poor; or (3) pullout forcefulness of the anchor was considered weak with accompanying osteoporosis of the greater tuberosity. Repairability was adamant based on preoperative MRI. In case of open repair, retraced cuff was mobilized after a full release of proximal region, in which repair was performed by using suture anchor or transosseous suture. The conclusion to operate on the patient was made past the senior author based on the patient's history, clinical findings, failed conservative management, and persistent pain. All operations were performed by the single senior author with the patient in a beach chair position.

All patients followed a standard postoperative rehabilitation programme. From the day of functioning, passive exercises including pendulum exercise, passive forward flexion and external rotation exercises were performed. Active exercises were not allowed until postoperative 6th week or until regaining total passive range of motility (ROM). Agile assisted exercises were started at postoperative sixth week and muscle strengthening exercises were introduced gradually thereafter.

Pre- and Postoperative Evaluations

All patients underwent a physical test one day before the operation. Postoperative evaluations were performed at 3, 6, ix, and 12 months and annually on an outpatient basis, and the results of the last follow-up were analyzed. Postoperative subjective pain scores at rest and during agile shoulder motion were measured on the visual analog scale (VAS). Quantitative muscle force measurements of the rotator gage were assessed using a portable handheld Nottingham Mecmesin Myometer (Mecmesin Co., Nottingham, UK). Elevation strength was tested with the patient in the seated position with the arm flexed to 90° in the scapular plane. External and internal rotation was tested with the shoulder in a neutral position and the elbow in 90° of flexion. For shoulder ROM, active forward flexion, external rotation at the side, internal rotation to the posterior, and abduction were assessed preand postoperatively. Internal rotation to the posterior was measured at the vertebral level of the paw. The Constant score¹⁶⁾ and the Shoulder Rating Scale of the University of California at Los Angeles (UCLA)¹⁷⁾ were used for the clinical assessment.

Cess of Repair Integrity

To appraise rotator cuff repair integrity, an anatomical evaluation of the gage repair was done using MRI every bit the modality of choice considering it allows for multiplanar imaging of the shoulder postoperatively.¹⁸⁾ Postoperative MRI was performed on all patients at least 12 month postoperative. All studies were obtained with a 3.0-T MRI using routine pulse sequences. All images were reviewed by an experienced senior radiologist. Integrity failure was assessed on MRI according to established MRI criteria;¹⁸⁾ and when a fluid-equivalent signal or non-visualization of the supraspinatus, infraspinatus, or subscapularis tendon was constitute on at least 1 T2-weighted or proton density-weighted image, the diagnosis of a full-thickness retear or anatomical healing failure was made. We classified the integrity of the tendon into 2 categories with MRI: (ane) healed (types I and Two) and (2) retear (types Three–5) on oblique coronal and oblique sagittal views according to Sugaya classification.^xix)

Statistical Analysis

The Wilcoxon rank sum test was performed to assess the difference between the preoperative and postoperative results. Comparisons between the two groups (healed and retear grouping) were performed using the Mann-Whitney U-test and the chi-foursquare examination for comparing proportions between groups. Correlation analysis using Fisher exact test was used to identify the correlation between various shoulder-specific functional result instruments at concluding follow-upward. Significance was fix at a level of 0.05 with associated 95% confidence intervals. The IBM SPSS ver 20.0 (IBM Co., Armonk, NY, United states) was used for all the statistical analyses.

RESULTS

Patient Demographics

All patients included in this written report were normal salubrious patients or patients with mild systemic disease without functional limitation who could be controlled by medication. A full of fifteen small to medium tears (threescore%), 5 big tears (twenty%), and 5 massive tears (20%) were examined in the current study. 19 patients (76%) underwent arthroscopic repair (14 pocket-size to medium tears, 2 big tears, and 3 massive tears) and vi (24%) underwent open up repair (one medium tear, 3 large tears, and 2 massive tears). Among the arthroscopic repairs, single-row repair was performed in 13 cases (52%) and suture-bridge repair in 6 cases (24%) (Tabular array 1).

Table i

Patient Demographics

Variable	No. (%)
No. of patients	25
Sex (male person:female person)	4:21
Historic period (yr), hateful (range)	78.3 (75–88)
Follow-up (mo), mean (range)	xxx.1 (12–108)
Tear size of rotator gage
Small to medium	15 (60)
Big	5 (xx)
Massive	5 (20)
Repair technique
Arthroscopic single row	13 (52)
Arthroscopic suture bridge	6 (24)
Open repair	half-dozen (24)

The hateful patient age was 77.5 years (range, 75 to 83 years) for the small to medium tear group, 79.2 years (range, 75 to 88 years) for the big tear group, and 79.half dozen years (range, 75 to 86 years) for the massive tear group. Larger tear size was correlated with increased hateful age, but the association was not significant (p = 0.235). The mean symptom elapsing was 9.9 months (range, 1 to 36 months) for the small-scale to medium tear group, 29.5 months (range, 12 to 85 months) for the large tear grouping, and 37.ix months (range, i.6 to 122 months) for the massive tear group. Larger tear size was correlated with longer mean symptom duration, but the association was insignificant (p = 0.472) (Table 2).

Tabular array 2

The Mean Age and Duration of Symptoms according to the Tear Size of Rotator Cuff

Tear size	Age (yr)	Symptom duration (mo)
Small to medium	77.5 (75–83)	9.9 (1–36)
Large	79.two (75–88)	29.5 (12–85)
Massive	79.half dozen (75–86)	37.9 (1.6–122)
p-value	0.235^*	0.472^†

Hurting

The mean VAS of the entire patient cohort improved significantly from five.4 ± 1.5 (range, three to eight) preoperatively to 1.8 ± 1.4 (range, 0 to 6) at the final follow-upward (p < 0.001). In the retear group, the mean VAS improved significantly from half-dozen.0 ± i.one (range, 4 to vii) preoperatively to 2.4 ± 1.eight (range, 0 to 6) at the final follow-upward (p < 0.001). In the healed grouping, it improved from 5.2 ± 1.half dozen (range, 3 to eight) preoperatively to 1.4 ± 0.9 (range, 0 to 3) at the terminal follow-up (p = 0.011). There was no pregnant difference in the postoperative VAS values betwixt the two groups (p = 0.934) (Tabular array 3).

Tabular array three

Clinical Outcomes of Patients in Retear Group and Healed Group

Variable	Retear group (n = 9)			Healed group (north = 16)			p-value^*
Variable	Preoperatively	Postoperatively	p-value	Preoperatively	Postoperatively	p-value	p-value^*
VAS	half dozen.0 ± 1.i	2.4 ± 1.eight	0.001^†	five.ii ± 1.half dozen	i.4 ± 0.nine	0.001^†	0.934
UCLA	14.4 ± iv.half-dozen	28.3 ± 4.three	0.008^†	15.viii ± three.8	31.i ± 2.iii	0.008^†	0.388
Constant	39.five ± 13.2	63.6 ± x.9	0.001^†	49.3 ± 11.i	71.9 ± 4.5	0.008^†	0.677
Range of motion
aFF (°)	117 ± 37	141 ± 26	0.037^†	137 ± 33	149 ± 12	0.049^†	0.301
ERs (°)	58 ± eighteen	51 ± 15	0.398	52 ± thirteen	44 ± 14	0.072	0.803
IRp	T12 ± two.0	T11 ± ii.vii	0.261	T12 ± 4.0	T11 ± iii.9	0.944	0.487
Abd (°)	136 ± 27	123 ± 29	0.078	124 ± 28	138 ± 24	0.360	0.095
Muscle strength (kg)
FF	3.1 ± ane.vii	four.3 ± 2.ix	0.206	4.ix ± 2.iii	seven.3 ± three.5	0.049^†	0.419
ER	4.4 ± 2.3	5.4 ± 2.5	0.214	5.4 ± 1.viii	7.7 ± 2.9	0.044^†	0.388
IR	5.4 ± 1.seven	6.7 ± 3.7	0.314	6.3 ± 2.2	viii.9 ± 3.2	0.015^†	0.301
Abd	3.4 ± 1.vi	4.9 ± 2.two	0.139	4.5 ± two.ane	6.iv ± 2.3	0.002^†	0.890

ROM

The mean preoperative ROM of the entire patient accomplice for active forward flexion (aFF), external rotation at the side (ERs), internal rotation to the posterior (IRp), and abduction (Abd) improved from 130°, 55°, T12, and 128° to 146°, 46°, T11, and 133° at the final follow-up, respectively. The postoperative improvement of aFF was statistically significant (p = 0.038), but there were no significant differences in postoperative ROM of ERs, IRp, or Abd (p = 0.052, 0.443, and 0.952, respectively).

In the retear grouping, the hateful preoperative ROM values for aFF, ERs, IRp, and Abd were 117°, 58°, T12, and 136°, respectively. At the concluding follow-upward, the mean ROM values were 141°, 51°, T11, and 123° (p = 0.037, p = 0.398, p = 0.261, and p = 0.078, respectively). In the healed group, the mean ROM for aFF, ERs, IRp, and Abd improved from 137°, 53°, T12, and 124° to 149°, 44°, T11, and 138° (p = 0.049, p = 0.072, p = 0.944, and p = 0.360, respectively) at the final follow-up. The postoperative improvement in aFF in both groups was statistically pregnant, just at that place were no significant differences in postoperative ROM values of aFF, ERs, IRp, and Abd between the ii groups (Table 3).

Musculus Strength

The mean muscle strength of the entire patient accomplice for forrad flexion (FF), external rotation (ER), internal rotation (IR), and Abd improved from the preoperative mean of 4.3, five.0, 6.0, and 4.ii kg to 6.2, 6.nine, 8.ane, and 5.9 kg at the final follow-upwards (p = 0.020, p = 0.023, p = 0.008, and p = 0.001, respectively).

In the retear group, the mean muscle forcefulness of FF, ER, IR, and Abd improved slightly but not significantly (p = 0.260, p = 0.214, p = 0.314, and p = 0.139, respectively). On the other hand, in the healed group, postoperative improvement in muscle strength in all directions was significant (p = 0.049, p = 0.044, p = 0.015, and p = 0.002, respectively). The postoperative values between the 2 groups did not prove significant differences (p = 0.419, p = 0.388, p = 0.301, and p = 0.890, respectively) (Tabular array 3).

Clinical Cess

The mean UCLA score increased from 15.3 points (range, 9 to 23 points) preoperatively to 31.9 points (range, 21 to 33 points) at the last follow-up (p < 0.001). The mean Abiding score increased from 45.8 points (range, eighteen to 62 points) preoperatively to 68.9 points (range, 43 to 80 points) at the concluding follow-upward (p < 0.001).

In the retear grouping, the mean UCLA score improved from 14.4 (range, 9 to 23) preoperatively to 28.3 (range, 21 to 35) at the terminal follow-up (p = 0.008). Similarly, it improved from 15.8 (range, 10 to 23) preoperatively to 31.ane (range, 26 to 33) at the final follow-upwards in the healed group (p = 0.008). The mean Constant score increased from 39.5 (range, 18 to 59) preoperatively to 63.6 (range, 55 to 76) at the final follow-up in the retear grouping (p < 0.001) and from 49.3 (range, 27 to 62) preoperatively to 71.nine (range, 61 to 80) at the final follow-up in the healed group (p = 0.008). The pre- and postoperative clinical scores of the retear group were junior to those of the healed group, but there was no significant deviation in the UCLA and Abiding scores betwixt the 2 groups at the final follow-up (p = 0.388 and p = 0.677, respectively) (Tabular array iii).

Structural Consequence

In that location were nine patients (36%) in the retear group. The mean age at surgery was 77.3 years (range, 75 to 81 years) for the healed group and 80.0 years for the retear grouping (range, 75 to 88 years). The hateful age at surgery was lower in the healed group, but the difference was insignificant (p = 0.389). There were 2 pocket-size to medium tears, iii large tears, and 4 massive tears in the retear grouping, as compared with xiii, ii, and ane in the healed group (p = 0.024). At that place were no significant differences in sex limerick, mean follow-up menstruum, or repair technique between the 2 groups (p = 0.542, p = 0.284, and p = 0.072, respectively), but at that place was a significant difference in initial tear size (p = 0.024, respectively) (Table 4).

Table iv

The Influencing Factors in Retear and Healed Groups

Variable	Retear group	Healed grouping	p-value
No. of patients	ix (36)	16 (64)
Sex (male:female person)	1:08	3:13	0.542
Age (yr)	fourscore.0 (75–88)	77.iii (75–81)	0.389
Follow-up (mo)	37.8 (12–108)	25.8 (12–65)	0.284
Tear size of rotator cuff			0.024^*
Pocket-sized to medium	2 (22)	13 (81)
Large	3 (33)	2 (xiii)
Massive	iv (44)	ane (vi)
Repair technique			0.072
Arthroscopic single row	3 (33)	x (63)
Arthroscopic suture bridge	two (22)	5 (31)
Open up repair	five (56)	i (half dozen)

Retear was significantly correlated with initial tear size (p = 0.001; odds ratio [OR], ii.771; 95% conviction interval [CI], ane.394 to five.509 for large to massive tears) (p = 0.001; OR, 0.183; 95% CI, 0.048 to 0.692 for pocket-sized to medium tears) only not with historic period (p = 0.177) or sex (p = 1.000; OR, 0.542; 95% CI, 0.048 to half dozen.144).

DISCUSSION

RCT have little inherent capacity to heal without operative handling.⁷ ^,viii) The surgical repair of RCT in young agile patients is a widely accustomed therapeutic option. Many studies have shown significant functional comeback and favorable tendon healing afterwards rotator cuff repair.^eleven ^,nineteen) Even so, there is insufficient evidence to suggest efficacy of operative treatment for RCT in elderly patients.¹³⁾ In near cases, the first choice remains conservative direction, but surgical treatment should be considered for symptomatic rotator cuff lesions that are unresponsive to conservative intendance. Whether debridement or repair should be considered in elderly patients is even so unclear. Several studies have suggested that only subacromial decompression with acromioplasty should be performed in elderly subjects with RCT.²⁰⁾ Acromioplasty lone yields satisfactory brusk-term results afterward RCT treatment.²¹⁾ However, deterioration is subsequently observed over the course of several years.²²⁾

Many studies have reported improved clinical outcomes after rotator cuff repair in elderly patients. Flurin et al.²³⁾ reported comeback from a preoperative Abiding score of 44 to 76 postoperatively and an American Shoulder and Elbow Surgeons (ASES) score of 35 to 54 postoperatively at one twelvemonth of follow-upwards in patients ≥ 70 years of age. Robinson et al.²⁴⁾ evaluated the arthroscopic rotator gage repair of 68 patients ≥ 70 years of age. They reported an improved Constant score from 23 preoperatively to 58 at the final follow-up in patients ≥ seventy years of age. Verma et al.^ix) evaluated 39 shoulders in patients ≥ 70 years undergoing arthroscopic repair of RCT. They reported that the ASES score improved from 45.8 to 87.5 and that the VAS score improved from 4.vi to 0.5 at final follow-upwards. Worland et al.²⁵⁾ studied 69 open up rotator gage repairs in patients anile ≥ 70 years. Satisfactory UCLA scores were achieved in 78%. Similarly, the findings of our study showed that the VAS, UCLA, and Abiding scores plus musculus strength improved significantly after rotator cuff repair.

Although successful results after gage repair take been reported, others reported that age and initial tear size are a negative gene associated with poorer tendon healing. Charousset et al.¹²⁾ reported healing in 52% of patients aged ≥ 65 years. Boileau et al.¹¹⁾ institute that patients aged ≥ 65 years had just a 43% chance of tendon healing and patients ≥ 65 years with delamination of the subscapularis or the infraspinatus had an even lower charge per unit of healing. Liu and Baker²⁶⁾ reported a retear rate of 32% and that tear size at the fourth dimension of the repair was a major determinant of cuff integrity afterward repair. Cole et al.²⁷⁾ reported a retear charge per unit of 22% in 47 patients and showed that the presence of a recurrent tear was significantly correlated with patient age and initial tear size. In the electric current study, the retear rate was 36% of 25 patients and the gage lesion healing charge per unit in elderly patients with a mean age of 78.three years was 64% (16 patients). In addition, amidst the 9 patients with retears, most (7 patients; 78%) had large to massive initial tears, while the healing rate in elderly patients with pocket-size to medium initial tears (xv patients) was 87%. These results are similar to the previously reported healing charge per unit of 78%–88% in patients aged ≤ 60 years.²⁷ ^,28) The hateful age at surgery was 77.3 years (range, 75 to 81 years) for the healed group and 80.0 years for the retear group; hence, the hateful age of the retear group was higher, as compared to that of the healed grouping, simply without significance. The initial tear size was the only factor affecting the retear rate.

Klepps et al.²⁹⁾ reported that postoperative gage integrity did not have a significant effect on outcome, as compared with intact cuffs in 32 patients. Another study suggested that rotator gage repair significantly decreased pain and improved function and strength, despite repair failure on MRI.²⁸⁾ They likewise reported that patients with a retear however showed significant improvement in all clinical assessments, including force.²⁸⁾ Liu and Bakery²⁶⁾ also demonstrated that repair integrity did not influence functional outcome. On the reverse, Flurin et al.²³⁾ reported that retorn cuffs had worse overall Constant and ASES scores. Cole et al.²⁷⁾ reported that ROM and muscle force in aFF were inversely correlated with a recurrent tear. Yoo et al.³⁰⁾ reported that concrete component summaries of the Short Form-36 as well as on the UCLA and ASES were significantly college in the healed group, even though in that location was no meaning departure in mental component summary scores. Thus, controversy persists about whether structural repair integrity affects functional outcome. In the electric current report, at that place was no significant difference in Constant and UCLA score, ROM, and muscle strength at the final follow-up between the retear and healed groups. It is likely that structural integrity after gage repair did not affect clinical consequence.

The electric current written report had a few limitations. Commencement, we analyzed brusque-term results with a mean follow-up of 30 months. Farther long term follow-up studies with larger groups of patients are needed. However, our study provides valuable information almost clinical outcomes and structural integrity after rotator cuff repair in patients aged ≥ 75 years. Second, with regard to postoperative imaging evaluation, the postoperative repair integrity was not analyzed by arthrography, but images were obtained for all included patients by MRI at a minimum of 12 months postoperatively. Nosotros did not measure the retear size or tendon retraction. However, partial-thickness tears or those with 50% of the normal rotator cuff thickness every bit documented past MRI were defined as retears to reduce the false-positive results rate in the present study. Third, the patient groups were heterogeneous regarding operative technique (arthroscopic or open up repair procedures). Open up repair was performed when arthroscopic repair was considered extremely challenging or rotator cuff tendon tissue or bone quality was poor. This selection bias may have contributed to the higher retear rate in the open repair group. In addition, the data of the patients' medical comorbidities were non described. Finally, our study had limitations similar to other retrospective studies. Even so, it as well had several strengths. Outset, all surgeries were performed by 1 senior author. 2nd, there are currently only a few published articles on the evaluation of clinical and anatomical results in elderly patients. And finally, we focused only on elderly patients and subdivided them into the retear and healed groups for comparison.

In conclusion, we demonstrated significant improvements in clinical outcomes after rotator cuff repair in patients aged ≥ 75 years. Structural integrity after rotator gage repair did not touch last clinical outcome. Fifty-fifty in elderly patients aged ≥ 75 years, high healing rate of a repaired RCT over 85% was shown in cases of small-scale to medium tears. Although the retear rate was relatively high for large to massive tears, clinical outcomes were still significantly improved. Therefore, healing potential can be expected in elderly patients aged ≥ 75 years who have RCT and in whom surgical repair tin can be attempted.

Footnotes

CONFLICT OF INTEREST: No potential conflict of interest relevant to this commodity was reported.

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