Two-year results of double row repair for medium sized rotator cuff tear in elderly patients

Authors

  • Afsar T. Ozkut Department of Orthopaedics and Traumatology, Goztepe Training and Research Hospital, Istanbul, Turkey

DOI:

https://doi.org/10.18203/2349-2902.isj20190043

Keywords:

Cuff repair, Double-row, Elderly

Abstract

Background: Rotator cuff tears are treated surgically when conservative treatment methods fail. Since osteoporosis is common and the cuff is degenerative in nature, it may be a challenge to treat the tears surgically in the elderly. The objective of this study was to evaluate the results rotator cuff repair with double row two anchors (one medial and one lateral) for middle sized tears in patients over 65years old.

Methods: 18 patients who are over 65years old treated arthroscopically for medium sized rotator cuff tear were included in the study. Inclusion criteria were patients with MR findings and physical findings consistent with medium sized (1-3cm) rotator cuff tears, patients with follow up period of at least 2years. All of the patients were repaired using (two anchors, one medially and one laterally placed) double row technique arthroscopically.  The patients were evaluated with constant Murley score and ASES scores. All these measurements (both ROM and functional tests) were performed preoperatively and at postoperative third sixth months, first year and after second year.

Results: Mean age of the patients was 69.3 (±2.6). The mean follows up period was 34months (±4.1) Preoperative mean forward flexion and external rotation were 127.3±25.3º and 48.9±14.6º respectively. The preoperative mean internal rotation was 9.1±6.9º. Preoperative mean ASES score was 59.1º (±9.6) and mean constant score was 53.7º (±11.2). At the last follow up mean forward flexion was 158.3º (±17.9), external rotation was 63.2º (±11.4) and internal rotation was 9.3º (±7.3).  Mean ASES score and constant score of the patients were 84.3 (±9.1) and 77.3 (±10.8) in the last follow up.

Conclusions: It is possible to obtain good results in medium sized rotator cuff tears in patients over 65years old particularly if fatty degeneration over grade II has not prevailed.

References

Hattrup SJ, Ariz S. Rotator cuff repair: relevance of patient age. J Shoulder Elbow Surg. 1995;4:95-100.

Rhee YG, Cho NS, Yoo JH. Clinical outcome and repair integrity after rotator cuff repair in patients older than 70years versus patients younger than 70years. Arthroscopy: J Arthroscopic Related Surg. 2014;30(5):546-54.

Fehringer EV, Sun J, Vanoeveren LS, Keller BK, Matsen III FA. Full-thickness rotator cuff tear prevalence and correlation with function and co-morbidities in patients sixty-five years and older. J Shoulder Elbow Surg. 2008;17(6):881-5.

Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8(4):296-9.

Yamaguchi K. Mini-open rotator cuff repair: an updated perspective. Instr Course Lect. 2001:53-61.

Gerber C, Meyer DC, Schneeberger AG, Hoppeler H, Von Rechenberg B. Effect of tendon release and delayed repair on the structure of the muscles of the rotator cuff: an experimental study in sheep. JBJS. 2004;86(9):1973-82.

Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001;10(3):199-203.

Boorman RS, More KD, Hollinshead RM, Wiley JP, Mohtadi NG, Lo IK, et al. What happens to patients when we do not repair their cuff tears? five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2018;27(3):444-8.

Deorio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg. Am Vol. 1984;66:563-7.

Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre-and postoperative evaluation by CT scan. Clin Orthopaedics Related Res. 1994:78-83.

Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg. 1999;8(6):599-605.

Oh JH, Kim SH, Lee HK, Jo KH, Bin SW, Gong HS. Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation. Arthroscopy: J Arthroscopic Related Surg. 2008;24(9):983-91.

Dunn WR, Kuhn JE, Sanders R, An Q, Baumgarten KM, Bishop JY, et al. 2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2016;25(8):1303-11.

Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal?. JBJS. 2005;87(6):1229-40.

Gwark JY, Sung CM, Na JB, Park HB. Outcomes of arthroscopic rotator cuff repair in patients who are 70years of age or older versus under 70years of age: a sex-and tear size-matched case-control study. Arthroscopy: Journal Arthroscopic Related Surg. 2018: 34(7):2045-2053.

Hattrup SJ, Ariz S. Rotator cuff repair: relevance of patient age. J Shoulder Elbow Surg. 1995;4:95-100.

Park JG, Cho NS, Song JH, Baek JH, Jeong HY, Rhee YG. Rotator cuff repair in patients over 75years of age: clinical outcome and repair integrity. Clin Orthopedic Surg. 2016;8(4):420-7.

Rashid MS, Cooper C, Cook J, Cooper D, Dakin SG, Snelling S, et al. Increasing age and tear size reduce rotator cuff repair healing rate at 1year: Data from a large randomized controlled trial. Acta Orthopaedica. 2017;88(6):606-11.

Boughebri O, Roussignol X, Delattre O, Kany J, Valenti P. Small supraspinatus tears repaired by arthroscopy: are clinical results influenced by the integrity of the cuff after two years? functional and anatomic results of forty-six consecutive cases. J Shoulder Elbow Surg. 2012;21(5):699-706.

Lee YS, Jeong JY, Park CD, Kang SG, Yoo JC. Evaluation of the risk factors for a rotator cuff retear after repair surgery. Am J Sports Med. 2017;45(8):1755-61.

Han Oh J, Hoon Kim S, Kang JY, Hee Oh C, Gong HS. Effect of age on functional and structural outcome after rotator cuff repair. Am J Sports Med. 2010;38(4):672-8.

Chung SW, Oh JH, Gong HS, Kim JY, Kim SH. Factors affecting rotator cuff healing after arthroscopic repair: osteoporosis as one of the independent risk factors. Am J Sports Med. 2011;39(10):2099-107.

Lo IK, Burkhart SS. Double-row arthroscopic rotator cuff repair: re-establishing the footprint of the rotator cuff. Arthroscopy: J Arthroscopic Related Surg. 2003;19(9):1035-42.

Kim DH, ElAttrache NS, Tibone JE, Jun BJ, DeLaMora SN, Kvitne RS, et al. Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med. 2006;34(3):407-14.

Grasso A, Milano G, Salvatore M, Falcone G, Deriu L, Fabbriciani C. Single-row versus double-row arthroscopic rotator cuff repair: a prospective randomized clinical study. Arthroscopy: J Arthroscopic Related Surg. 2009;25(1):4-12.

Sugaya H, Maeda K, Matsuki K, Moriishi J. Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy: J Arthroscopic Related Surg. 2005;21(11):1307-16.

Lee SH, Kim JW, Kim TK, Kweon SH, Kang HJ, Kim SJ, et al. Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size?. Knee Surg, Sports Traumatol, Arthroscopy. 2017;25(7):2138-46.

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Published

2019-01-28

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Original Research Articles