Arthroscopic treatment of rotator cuff tear in the over-60s: repair is preferable to isolated acromioplasty-tenotomy in the short term.

INTRODUCTION

The principal study objective was to compare clinical results for arthroscopic repair of rotator cuff tear and acromioplasty-tenotomy in patients aged over 60 years.

HYPOTHESES: Repair provides better clinical results than isolated acromioplasty-tenotomy. Shoulder function is improved when healing is obtained.

PATIENTS AND

METHODS

One hundred and forty-two patients aged over 60 years (mean age, 67 years) presenting with reparable supraspinatus tear, extending to a greater or lesser degree to the infraspinatus, agreed to take part in a randomized prospective study. Fifteen were excluded from statistical analysis. All underwent acromioplasty and biceps tenotomy. They were randomly assigned to arthroscopic rotator-cuff repair (CR group) or not (AT group). The principal evaluation criterion was mean weighted Constant score at one year's follow-up. Healing in the CR group was assessed on ultrasound at one year.

RESULTS

The complications rate was 7.9%. Mean weighted Constant score was significantly better in group CR: 75.8%, versus 68.8% in AT. In the CR group, the 1-year healing rate was 67.6%. Healing significantly impacted mean weighted Constant score: 80% with healing, versus 66.9% in iterative tearing. Whatever the size of the tear, mean weighted Constant score was significantly better in patients with than without (no repair or iterative tear) tendon healing.

DISCUSSION: The study demonstrated the interest of arthroscopic rotator cuff repair in patients aged over 60 years. The benefit of repair compared to isolated acromioplasty-tenotomy depended on tendon healing.

LEVEL OF EVIDENCE: Randomized prospective study, level II.