Outcomes of Arthroscopic Rotator Cuff Repair in Patients Aged 70 Years or Older
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Rotator cuff tears are frequently encountered when caring for elderly patients. Previous studies have reported the prevalence of full-thickness rotator cuff tears to be 5% to 33% in the general population and 22% in 52 those aged 65 years or older. As described by Neer, a vast majority of rotator cuff tears result from chronic degenerative changes due to impingement, and the incidence has been shown to increase with patient age.
Because elderly individuals increasingly desire to remain physically active, their activity expectations often justify surgical treatment of a rotator cuff lesion. Many operative interventions have been advocated, and controversy exists over the indications for surgical management and indications for repair versus debridement alone in this age group. However, it is noted that rotator cuff repair has been shown to provide consistently better results than debridement alone. Older patients, however, often present unique surgical challenges. As noted by Hattrup, patients aged 65 years or older were significantly more likely to have a larger tear size, which could potentially increase the difficulty of repair. Histologic analysis of rotator cuff tendon tissue at different ages has shown that tendon cellularity and vascularity are markedly diminished at age 70 years, even when compared with corresponding tendon tissue at age 50 years. Bone quality is also inferior, resulting from osteoporosis of the greater tuberosity, cystic degeneration, and irregularity of cortical margins, which may significantly complicate suture anchor fixation. Finally, elderly individuals frequently have comorbidities (diabetes, rheumatoid arthritis, renal disease) that may weaken the healing response and complicate surgical management.
Although limited results have been reported with open and mini-open rotator cuff repair in the elderly, results of arthroscopic rotator cuff repair (ARCR) in elderly patients, specifically those aged 70 years or older, have not been well studied. ARCR has the advantages of a small incision and no deltoid morbidity, resulting in quicker recovery than traditional approaches. In addition, it can commonly be performed as an outpatient procedure with the patient under regional anesthesia. However, there may be concern that the quality of bone and tendon and the large tear size in this population may complicate suture anchor repair by use of minimally invasive methods. The purpose of this study was to evaluate the outcomes of ARCR in patients aged 70 years or older and report our results in the context of normalized, age- and sex-matched shoulder score values. The hypothesis was that arthroscopic repair in patients aged 70 years or older would provide significant improvement in pain and function, with limited complications.