Summary

Despite significant fatty atrophy, osteoporosis and retraction of tear arthroscopic single row repair in elderly gives good results. In addition it is cost effective in this era of rising medical expenses worldwide.

Abstract

Background

Many studies have shown good functional outcomes in young and middle age patients with double row rotator cuff repair but few studies have shown radiological and function outcome of single low repair in old and very old patients. This study focuses on functional, clinical and radiological outcome of single row rotator cuff repair in patients more than age 65 years.
Methods:We performed a retrospective analysis of 40 patients of aged > 65 years who underwent arthroscopic single row rotator cuff repair. Out of 40 patients 9 patients were lost to follow up. So 31 patients (17 females and 14 males) with 35 shoulders (4 bilateral shoulders) were finally included for study. We evaluated functional, clinical and radiological (radiograph and ultrasonography) outcomes after arthroscopic rotator cuff repair. A minimum 9 month follow up was performed by an independent examiner for range of motion, strength testing, and shoulder functional outcome scores including the Constant Murley Score, UCLA, Simple Shoulder Test score, and Pain score on a visual analog scale were determined.

Results

The mean age at the time of surgery was 69.4 years (range, 65 to 79 years) while mean follow up was 39.74 months (range, 13 to 144 months). Average retraction of tear was 1.65 cm. Average fatty atrophy was 1.28 (Gautallier grade) preoperatively. Post-operative average functional Constant Murley score was 98.35+/- 3.94 as compared to preoperative score of 71.13+/- 5.89 (P value <0.001)). Average postoperative UCLA score of 34.42+/- 1.29 from preop 23.52+/-2.26. (P value <0.001). Post-operative Simple shoulder Test score was 11.71+/-0.46 compared to preop 6.52+/-0.85 (P value <0.001). Pain score on visual analogue scale was post-op 14.7+/-0.3 compared to preop 9.23+/-1.20 (P value<0.001). Average active Forward elevation was improved from preop 106.77+/-26.88 to 170+/- 7.75 post-op.(P value <0.001).Average external rotation at the side was post-op 85.16+/- 5.08 from 66.45+/- 9.5 preop (P value <0.001). Internal rotation to posterior at the final followup was T8 on an average from L5 preop. The mean muscle strength improved from 2.84+/- 0.45 preoperatively to 5 post operatively on MRC scale(P value<0.001). On radiographic study at final followup radiographs were suggestive of acromioclavicular distance of mean 8.45+/- 2.15mm compared to preop AHD 6.03+/- 1.52 of (P value<0.001) . In post-operative ultrasonographic study retear was seen in 1 case without functional deficit or pain, tendinosis was seen in 2 cases. Average Sugaya grading for post operative repair status was 1.17.

Conclusion

Arthroscopic rotator cuff single row repair provides significant functional improvement and good cuff tear healing rates in more than 65 age group. Despite significant fatty atrophy, osteoporosis and retraction of tear arthroscopic single row repair in elderly gives good results. In addition it is cost effective in this era of rising medical expenses worldwide.