Repair of Rotator Cuff Tears in the Elderly: Does It Make Sense? A Systematic Review

Abstract

Background: The indications and outcomes for rotator cuff repair (RCR) among patients ≥70 years old are not widely reported. Many active patients in this age range desire a joint-preserving option, and several small series reported successful clinical outcomes after RCR among patients aged ≥70 years. Purpose: To systematically review the literature on the outcomes of RCR among patients ≥70 years old. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The electronic databases of PubMed and Cochrane were used for the literature search. The quality of the included studies was evaluated according to the Coleman Methodology Score. Studies in English evaluating repair of full-thickness rotator cuff tears among patients aged ≥70 years were included. Results: Eleven studies were reviewed, including 680 patients (694 shoulders) who were treated with arthroscopic and/or open RCR with a mean follow-up of 24.2 months (range, 12-40.8 months). Forty patients were lost to follow-up, leaving 654 shoulders with outcome data. This age group demonstrated a significant increase in clinical and functional outcomes after RCR with high satisfaction. American Shoulder and Elbow Surgeons scores showed an improvement from 44.2 (range, 35.4-56) preoperatively to 87.9 (range, 84-90.3) postoperatively, while Constant scores improved from 41.7 (range, 22.6-53.6) to 70.8 (range, 58.6-76). Postoperative imaging evaluation was performed on 513 shoulders, revealing a retear rate of 27.1% (139 shoulders). There were 45 retears after open repair and 94 after arthroscopic repair. The difference in retear rate among patients receiving arthroscopic repairs was not significantly different than open repairs ( P = .831). Pain according to a visual analog scale improved from 5.5 (range, 4.6-6.4) preoperatively to 1.3 (range, 0.5-2.3) postoperatively. Conclusion: RCR among patients ≥70 years old shows high clinical success rates with good outcomes and overall excellent pain relief. Although patients in this age group have a high potential for retear or persistent defects on imaging studies, RCR offers a joint-preserving option with significant functional and clinical improvement for the appropriately indicated patient.

Outcomes after rotator cuff repair in the elderly as assessed by the American Shoulder and Elbow Surgeons shoulder score

“…Although rotator cuff tears are common in the elderly population, both the surgeons and patients have been hesitant towards surgical repair because of the various risk factors for failure, including decreased bone density, and tendon vascularity, as well as comorbidities among elderly patients ( 1 , 2 ). However, there have been increasing demands for surgical repair of rotator cuff injuries among these patients ( 2 , 6 ).…”

“…All these terms were searched in TITLE/ABSTRACT. We also reviewed the reference lists of eligible original articles and previous systematic reviews to identify additional studies (1,2,(6)(7)(8)10).…”

“…Rotator cuff tears are common conditions in all age groups, but the risk increases with age ( 1 , 2 ). Particularly, the severity of rotator cuff tears, such as tear size, may be higher among the elderly and is associated with increased pain and impaired quality of life in these patients ( 3 , 4 ).…”

“…A few previous studies have evaluated the outcomes after rotator cuff repair in the elderly patients, and the results vary between populations, and particularly are dependent on the tools used for assessing the post-operation outcomes (1,(6)(7)(8)(9)(10). Among the used assessment tools, the American Shoulder and Elbow Surgeons (ASES) shoulder score is one of the most validated outcome reporting measure, which can be used in patients with a wide range of shoulder diagnoses including rotator cuff injuries (11).…”

Ultrasound-Guided Percutaneous Tenotomy of the Long Head of Biceps Tendon in Patients with Symptomatic Complete Rotator Cuff Tear: In Vivo Non-contRolled Prospective Study

“…Conservative treatment has success rates ranging from 40% to 82% [ 2 , 3 ], although frequent complications such as reduction of subacromial space and progression of glenohumeral arthritis are reported in the literature [ 4 ]. Surgical treatment of complete RC tears may be the most appropriate choice [ 5 , 6 , 7 ]. However, although surgical RC repair generally guarantees satisfactory results, the rate of re-tearing can be up to 70%, particularly in cases of massive lesions and in patients over 65 years of age [ 8 , 9 , 10 , 11 ].…”