Rotator cuff tears after 70 years of age: A prospective, randomized, comparative study between decompression and arthroscopic repair in 154 patients - 07/11/13

Doi : 10.1016/j.otsr.2013.10.005

P.-H. Flurin ^a,^⁎ , P. Hardy ^b, P. Abadie ^a, P. Desmoineaux ^c, J. Essig ^d, T. Joudet ^e, C. Sommaire ^f, C.-E. Thelu ^g
the
French Arthroscopy Society (SFA)^h
^a Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges-Nègrevergne, 33700 Mérignac, France
^b CHU Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
^c Hôpital André-Mignot, Pôle ABCDO, 177, rue de Versailles, 78157 Le Chesnay, France
^d Médipole Garonne, 45, rue de Gironis, 31036 Toulouse, France
^e Centre orthopédique du Libournais, 119, avenue de la Marne, 33500 Libourne, France
^f CCOM, CHU Strasbourg, 10, avenue Achille-Baumann, 67400 Illkirch, France
^g Hôpital Archet 2, 151, route St-Antoine-de-Ginestière, 06200 Nice, France
^h Cabinet médical, 18, rue Marbeuf, 75008 Paris, France

^⁎Corresponding author. Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France. Tel.: +33 5 56 12 14 40.

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En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Thursday 07 November 2013
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Summary

Introduction

Arthroscopic repair of rotator cuff tears leads to better clinical outcomes than subacromial decompression alone; however the former is rarely proposed to patients above 70years of age. Our hypothesis was that arthroscopic repair would be superior to decompression in patient 70years or older. The primary goal was to compare the clinical results obtained with each technique. The secondary goal was to analyze the effects of age, tendon retraction and fatty infiltration on the outcome.

Methods

This was a prospective, comparative, randomized, multicenter study where 154 patients were included who were at least 70years of age. Of the included patients, 143 (70 repair and 73 decompression) were seen at one-year follow-up; these patients had an average age of 74.6years. Shoulders had a complete supraspinatus tear with extension limited to the upper-third of the infraspinatus and Patte stage 1 or 2 retraction. Clinical outcomes were evaluated with the Constant, ASES and SST scores.

Results

All scores improved significantly with both techniques: Constant +33.81 (P<0.001), ASES +52.1 (P<0.001), SST +5.86 (P<0.001). However, repair led to even better results than decompression: Constant (+35.85 vs. +31.8, P<0.05), ASES (+56.09 vs. +48.17, P=0.01), SST (+6.33 vs. +5.38, P=0.02). The difference between repair and decompression was not correlated with age; arthroscopic repair was also better in patients above 75years of age (Constant, ASES and SST scores P<0.01). There was no significant correlation between the final outcomes and initial retraction: Constant (P=0.14), ASES (P=0.92), SST (P=0.47). The difference between repair and decompression was greater in patients with stages 0 and 1 fatty infiltration (Constant P<0.02) than in patients with stages 2 and 3 fatty infiltration (Constant P<0.05).

Conclusion

There was a significant improvement in all-clinical scores for both techniques 1year after surgery. Repair was significantly better than decompression for all clinical outcomes, even in patients above 75years of age. The difference observed between repair and decompression was greater in patients with more retracted tears and lesser in patients with more severe fatty infiltration.