Summary

This study shows that primary rotator cuff repair in patients aged 80 and above yields excellent clinical, functional, and mental outcomes, with 86% reporting satisfaction and minimal disability at a 51-month follow-up, despite the higher risk of retears, making it a highly effective joint-preserving option for elderly patients.

Abstract

Title: Mid-term Clinical Evaluation of Primary Rotator Cuff Repair in Patients Aged 80 and above

Background

There is limited documentation on the indications and outcomes of primary rotator cuff repair in the elderly, particularly in those aged 80 years and above. In developed countries, a significant proportion of the elderly population prefers joint-preserving surgical interventions to maintain an active lifestyle. This study aimed to evaluate the medium-term outcomes of primary rotator cuff repair in patients over 80 years old.

Methods

A retrospective analysis was conducted on a cohort of 75 consecutive patients (aged >80 years) who underwent primary arthroscopic repair for rotator cuff tears between January 1, 2017, and December 31, 2018. Patients who had partial tear reconstructions were excluded. Clinical evaluations included the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numeric Evaluation (SANE) score, Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score, and the Short Form 12 Health Survey Questionnaire (SF-12v2). Questionnaires, along with participation consent forms, patient information sheets, and self-addressed envelopes, were mailed to participants. Only fully completed forms with signed consent sheets were included in the analysis.

Results

By March 31, 2023, 62 completed forms were received. The study subgroup consisted of 43 males (69%) and 19 females (31%), with a mean age of 82.1 years (range: 80-105; median: 81 years). Two-thirds of the patients had massive tears involving more than two tendons. At an average follow-up of 51 months (range: 49-58 months), 86% (53 patients) expressed satisfaction with their shoulder function. The mean SANE score was 89.5 (range: 40-100), while the mean Physical Component Summary (PCS) of SF-12v2 was 51.64 (range: 32.98-58.6), and the Mental Component Summary (MCS) was 55.44 (range: 49.61-62.38). The average ASES score was 88.4 (range: 47-100), and the mean Quick-DASH score was 7.88% (range: 0-43%), indicating favorable clinical outcomes with minimal disability.

Conclusions

Primary rotator cuff repair in patients aged 80 and above produces excellent clinical, mental, and functional outcomes at a minimum mid-term follow-up of four years. Despite the higher risk of retears in this age group, primary repair remains a highly effective joint-preserving option for elderly patients.