Rotator cuff surgery in patients older than 75 years with large and massive tears

Abstract

Background: The purpose of this study was to evaluate whether rotator cuff repair improves subjective and functional outcomes in patients aged ≥75 years.

Methods: From May 2005 to March 2013, 121 elderly patients who underwent rotator cuff repair for large and massive rotator cuff tears were evaluated retrospectively. Patients with an American Society of Anesthesiologists physical status classification system grade ≥4 were excluded. The patients were evaluated using visual analog scales, subjective satisfaction surveys, American Shoulder and Elbow Surgeons scores, and Constant scores. The Katz index of activity of daily living (ADL) and functional independence measure motor score were used to evaluate ADLs. Postoperative magnetic resonance imaging (MRI) was performed to investigate the structural integrity of repaired cuffs.

Results: In total, 64 patients were enrolled in the study; 80% were satisfied with their results. Visual analog scale scores improved from 6.4 to 2.3, American Shoulder and Elbow Surgeons scores from 42 to 84, and Constant scores from 42 to 76. Katz ADL scores improved from 3.4 to 5.0. Functional independence measure motor score improved from 22 to 51. Of the 64 patients, 46 underwent MRI 1 year postoperatively. Follow-up MRI revealed retears in 26% of patients. All patients with retears had improved subjective outcomes and functional scores. No patients died or experienced complications requiring intensive care or extended hospitalization.

Conclusions: Surgical treatment for large to massive rotator cuff tears in elderly patients with American Society of Anesthesiologists grade <4 provides good functional outcomes without morbidity, even in those with retears.

Keywords: Shoulder; functional outcome; geriatric population; morbidity; retear; rotator cuff repair; rotator cuff tear.