Summary

Arthroscopic cuff repairs result in excellent clinical outcomes for small to medium sized tears in elderly patients aged 65 and above, with clinically important improvements in VAS, CMS, UCLA and OSS scores seen at 1 year post-operatively. Contrary to our hypothesis, tendon thickness did not appear to have any effect on clinical outcomes at 2 years post-operatively.

Abstract

Introduction

Previous studies on rotator cuff tears have examined both clinical and radiographic parameters which may influence post-operative clinical outcomes. While rotator cuff tears are frequently classified by size (small, medium, large or massive) or depth (partial or full-thickness cuff tears), there is currently no literature available examining the objective thickness of the rotator cuff itself, and its impact on post-operative outcomes. We hypothesize that cuff thickness will be associated with clinical outcomes after arthroscopic rotator cuff repair in patients with full-thickness rotator cuff tears, especially in the elderly (aged > 65 years).

Methods

We prospectively recruited all patients aged 65 years and above who underwent arthroscopic repair of small to medium full-thickness rotator cuff tears at our institution. These patients were followed up for a minimum of 2 years post-operatively. Basic biodata, as well as Visual Analog Scale (VAS) for pain, Constant-Murley Score (CMS), UCLA Shoulder Score (USS), and Oxford Shoulder Score (OSS) at 3 different time points (pre-operatively, 1 year post-operatively, and 2 year post-operatively) were collected. Cuff thickness was measured by independent blinded radiologist on pre-operative ultrasonographic images. Repeated measures ANOVA was performed to determine differences in clinical scores between each time period. Multiple linear regression was used to examine the effect of tendon thickness, as well as other variables such as age and gender, on VAS, CMS, USS, and OSS at 2 years post-operatively.

Results

A total of 42 patients with minimum 2 year follow up were included in this study. There were 12 male and 30 female patients, and the cohort had a mean age of 74 (4) years. Mean tendon thickness measured was 5.3 (1.7) mm, and mean tear size was 1.5 (0.7) cm.

Regression analysis revealed that tendon thickness had no effect on VAS, CMS, UCLA, and OSS scores at 2 years post-operatively.

All clinical scores (VAS, CMS, USS, and OSS) improved significantly at 1 year post-operatively (p<0.05) when compared to pre-operative values, and all improvement in scores met the minimal clinically important differences (MCID) established in previous studies. While these scores continued to improve from 1 to 2 years post-operatively, the differences detected were no longer statistically significant (p>0.05).

Discussion

Arthroscopic cuff repairs result in excellent clinical outcomes for small to medium sized tears in elderly patients aged 65 and above, with clinically important improvements in VAS, CMS, UCLA and OSS scores seen at 1 year post-operatively. Contrary to our hypothesis, tendon thickness did not appear to have any effect on clinical outcomes at 2 years post-operatively. However, post-operative sonographic evaluation may shed further light on whether cuff thickness plays a role in tendon healing and retear rates, which are known to have poor correlation with clinical outcomes as well.