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Is Interposition Allograft Bridging Reconstruction Appropriate in Patients Older Than 60 Years Old? A Retrospective Mid-Term Analysis

Is Interposition Allograft Bridging Reconstruction Appropriate in Patients Older Than 60 Years Old? A Retrospective Mid-Term Analysis

Ivan Wong, MD, FRCSC, MACM, Dip. Sports Med, CANADA Sara Sparavalo, B.Sc., M.A.Sc., CANADA Jie Ma, CANADA

Nova Scotia Health Authority, Halifax, Nova Scotia, CANADA


2021 Congress   ePoster Presentation     Not yet rated

 

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Sports Medicine

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Summary: The results of our study demonstrate that even elderly patients with irreparable, massive cuff tears can have improved pain and function following treatment with bridging reconstruction.


Background

Rotator cuff tears are common in elderly populations with the main etiology being degeneration due to aging. Tears can be categorized many different ways including based on size and reparability. The prevalence of massive, irreparable cuff tears in patients over 65 has been reported to be as high as 22%. Recent operative treatment guidelines from the American Academy of Orthopaedic Surgeons has suggested that age may be a risk factor for failure of rotator cuff repair, and therefore many older patients are often treated using reverse total shoulder arthroplasty (rTSA), which is a costly and invasive procedure. Previous studies have investigated the differences between clinicoradiological outcomes of patients >60 years of age who have received rotator cuff repair and have compared them to patients <60 years of age. Because age is a risk factor for failure of cuff repair, it is important to consider in patients who received interposition allograft bridging reconstruction, which is a new treatment option for patients with irreparable rotator cuff tears. The purpose of our study was to determine whether bridging reconstruction results in positive patient-reported outcomes regardless of patient age.

Methods

We performed a retrospective review on consecutive patients with prospectively collected data who underwent interposition allograft bridging reconstruction by the senior author from 2015 to 2018. Patients who received bridging reconstruction for massive rotator cuff tears and had a minimum follow-up of two years were included. Exclusion criteria included patients with shoulder instability, irreparable subscapularis tears, and glenoid fractures. Eighty-one patients met the inclusion/exclusion criteria, and they were stratified into two age groups (<60 (n=39) and >60 (n=42) years of age). Our primary outcome was measured using the Western Ontario Rotator Cuff (WORC) Index. Secondary outcomes included post-operative Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires, post-operative complications and post-operative graft re-tears as assessed using magnetic resonance imaging (MRI).

Results

We had 81 patients meet our inclusion/exclusion criteria. Our patients had similar distributions of gender, operative side, and surgery type (i.e. primary or revision). Both groups demonstrated a statistically significant improvement in WORC and DASH scores from pre-op to most-recent follow-up (p<0.001, a=0.05). Over 85% of patients met the minimal clinically important difference (MCID) for WORC with no statistically significant difference between the two age groups (p=0.620). Moreover, there were no differences in incidence of graft re-tear as detected using MRI between the two groups.

Conclusion

The results of our study demonstrate that even elderly patients with irreparable, massive cuff tears can have improved pain and function following treatment with bridging reconstruction. Both patients below and above the age of 60 meet the MCID for WORC and DASH, suggesting that bridging reconstruction should be considered for this patient demographic rather than other more invasive treatments such as rTSA. Future studies investigating muscle quality and strength/range of motion should be considered to determine whether age affects those parameters in our patient group.


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