2015 ISAKOS Biennial Congress ePoster #2416

Rotator Cuff Tears After 70 Years: A Prospective, Randomized, Comparative Study Between Decompression and Arthroscopic Repair, About 154 Patients Aged 70 Years or More

Pierre-Henri Flurin, MD, Merignac FRANCE
Philippe P. Hardy, MD, PhD, Prof., Boulogne FRANCE
Pierre Abadie, MD, Merignac FRANCE
Julien Deranlot, MD, Boulogne FRANCE
Pierre Desmoineaux, MD, Le Chesnay FRANCE
Jerome Essig, Toulouse FRANCE
Thierry Joudet, MD, Libourne FRANCE
Christian Sommaire, MD, Strasbourg FRANCE
Charles Edouard Thelu, MD, Nice FRANCE
SFA French Society of Arthroscopy, Paris, FRANCE

FDA Status Not Applicable

Summary: Arthroscopic repair provides better clinical outcomes than decompression, however, it is rarely proposed to patients over 70. Our hypothesis was that suture remained more efficient than decompression in these patients. Main objective was to compare outcomes for both techniques. Secondary objective was to analyze the influence of age, retraction and fatty degeneration on results.

Abstract:

Introduction.
Athroscopic repair of rotator cuff tears leads to better clinical outcomes than subacromial decompression alone; however it is rarely proposed to patients above 70 years of age. Our hypothesis was that arthroscopic repair would be superior to decompression in that group of patients. The primary goal was to compare the clinical results obtained with each technique. The secondary goal was to analyze the effects of age, tendon retraction and fatty infiltration on the outcome.

Method.
This was a prospective, comparative, randomized, multi-center study where 154 patients above 70 years of age were included. Of the included patients, 143 (70 repair and 73 decompression) were seen at one-year follow-up; these patients had an average age of 74.6 years. The shoulders had a complete supraspinatus tear with extension limited to the upper third of the infraspinatus and Patte stage 1 or 2 retraction. Clinical outcomes were evaluated with the Constant, ASES and SST scores

Results.
All scores improved significantly for both techniques: Constant +33.81 (p<0.001), ASES +52.1 (p<0.001), SST +5.86 (p<0.001). However, repair led to even better results than decompression: Constant (+35.85 vs. +31.8 p<0.05), ASES (+56.09 vs. +48.17, p=0.01), SST (+6.33 vs. +5.38, p=0.02). The difference between repair and decompression was not correlated with age and suture remained aven better over 75 years old (Constant, ASES and SST scores p<0.01). There was no significant correlation between the final outcomes and initial retraction: Constant (p=0.14), ASES (p=0.92), SST (p=0.47). The difference between repair and decompression was greater in patients with Stage 0 and 1 fatty infiltration (Constant p<0.02) than in patients with Stage 2 and 3 fatty infiltration (Constant p<0.05).

Conclusion.
There was a significant improvement of all clinical scores, for both techniques, one year after surgery. Repair was significantly better than decompression, in all clinical scores, even in patients above 75 years of age. The difference observed between repair and decompression was greater in patients with more retracted tears and lesser in patients with more severe fatty infiltration.