Rotator cuff injury in patients over the age of 65 years: evaluation of function, integrity and strength

Abstract

ObjectiveTo retrospectively evaluate the results from patients who underwent arthroscopic treatment for rotator cuff injuries, among those aged over 65 years, observing integrity, function and strength.MethodsThirty-five shoulders were operated between July 2005 and July 2010, and 28 shoulders were re-evaluated regarding elevation strength and external rotation, using a digital dynamometer. Integrity was evaluated by means of ultrasound examinations. The patients, whose mean age was 70.54 years (ranging from 65 to 82 years), were followed up for a minimum of 26 months and mean of 51.18 months (ranging from 26 to 82 months). To evaluate function, the UCLA score, the Simple Shoulder Test (SST) and a visual analog scale (VAS) for pain were used.ResultsIn analyzing the ultrasound scans, it was observed that the integrity of the rotator cuff was maintained in 75% of the cases at the end of the follow-up, along with the improvement in the UCLA score, which evolved from 17.46 to 32.39, i.e. excellent and good results in 89.28%. The mean SST and VAS indices were 9.86 and 1.5 respectively.ConclusionArthroscopic surgery to repair rotator cuff injuries in patients over the age of 65 years leads to improved function and pain relief, with maintenance of the integrity of the repair. The data on muscle strength were inconclusive.

Surgical Treatment of Rotator Cuff Tears After 65 Years of Age: A Systematic Review

“…Bhatia et al 41 reported an ASES score improvement from 56 points to 90.3 points post op and an SF-12 PCS score increase from 43.0 to 51.6, both with statistical significance (p < 0.001). De Castro Veado 37 reported an UCLA score improvement from 17.46 points to 32.39 points post operative, corresponding to 89.28% of good and excellent results. Verma et al 19 reported ASES score improvement from 45.8 (SD ± 16.6) to 87.5 (SD ± 14.4) postoperative (p < 0.0001).…”

“…Clinical and structural results, in these patients, are comparable to younger patients and withholding rotator cuff repair because of age did not seem justified. 39 De Castro Veado et al 37 found UCLA score improvement in 27 out of 28 patients arthroscopically treated. Flurin et al 34 found that the clinical results are not correlated with age or frontal retractions (but only retractions stage 1 and 2 were included in this paper).…”

“…There were, however, a fair amount of correlations with statistical significance, and the population groups of the different studies were not ignorable. The study with the least cases was from De Castro Veado 37 and colleagues (n = 28), while Miyazaki et al 35 had the largest number of reported cases (n = 168).…”

“…Some studies excluded massive tears (> 5 cm). 33,34,37 Multiple tendon lesions were included in all studies under specific limitations. 32,39,41,44 Verma et al 19 excluded RCT with subscapularis involvement (100% had supraspinatus and 38.5% had infraspinatus involvement).…”

“…33,34 Non-reducible tears without tension or requiring intraoperative arthrolysis were excluded in both level II studies. Concomitant procedures were performed in all evaluated studies, there were, however, differences in the procedures, particularly, intra-articular actions ( [32][33][34]37,40 Cuff tear arthropathy in a preoperative x-ray was an exclusion criterion in other studies. 40 The paper by Miyazaki et al 35 featured broader inclusion criteria, thus, patients with instability, adhesive capsulitis and arthrosis were included (Table 2), whereas Veado et al 37 excluded SLAP and Bankart lesions.…”