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Abstract
Purpose:
This study analyzed the features of humeral head decentralization in large to massive rotator cuff tears with a shoulder dislocation in the elderly. Moreover, shoulder instability and treatment were reviewed.
Materials and Methods:
From May 2005 to February 2017, Group A containing 45 cases (45 patients) over 65 years old accompanied by a large or massive rotator cuff tear with a shoulder dislocation and Group B containing 45 cases (45 patients) without a shoulder dislocation were enrolled. The mean ages in Groups A and B were 73.2 and 72.1 years old, and the mean follow-up periods were 30.7 and 31.3 months, respectively. Twenty-one cases (46.7%) in Group A underwent rotator cuff repair, and 8 cases (17.8%) underwent concomitant rotator cuff repair with Bankart repair. Sixteen cases (35.6%) underwent reverse total shoulder arthroplasty for cuff tear arthropathy. 45 cases (100%) in Group B underwent rotator cuff repair. The off-the center and head elevation were measured in the preoperative magnetic resonance imaging (MRI) of Groups A and B. The preoperative and postoperative visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score in Groups A and B were compared.
Results:
In Groups A and B, the mean off-the centers were posterior 7.41 mm and posterior 2.02 mm (p=0.03), and the mean head elevations were superior 6.66 mm and superior 2.44 mm (p=0.02), respectively. The mean ASES scores of Groups A and B were 32.8 and 33.4 before surgery, and 77.1 (p=0.02) and 78.1 (p=0.02) after surgery (p=0.18), respectively. The mean UCLA scores of Groups A and B were 13.1 and 12.8 before surgery, and 28.9 (p=0.02) and 29.5 (p=0.01) after surgery (p=0.15), respectively.
Conclusion:
Patients over 65 years old with a shoulder dislocation in large to massive rotator cuff tears had higher off-the center and head elevation on the preoperative MRI than those without a shoulder dislocation. This measurement can help predict preceding shoulder instability. Early rotator cuff repairs should be performed and other treatments, such as Bankart repair and reverse total shoulder arthroplasty, should also be considered.
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Figure 1.
(A) A 74-year-old female with a massive rotator cuff tear showed 7.47 mm of off-the center and anterior labral tear on the axial magnetic resonance imaging. (B) She underwent arthroscopic rotator cuff repair with a Bankart repair.
Figure 2.
(A) A 77-year-old male with a massive rotator cuff tear showed 10.38 mm of head elevation and rotator cuff tear arthropathy (Seebauer’s classification type IB). (B) He underwent reverse total shoulder arthroplasty.
Figure 3.
Off-the center of humeral head, which means the distance between the humeral head center and glenoid center, was measured on axial magnetic resonance imaging. This shoulder image was measured to be 8.14 mm of the off-the center of humeral head.
Figure 4.
Head elevation of humeral head, which means the distance between the humeral head inferior margin and glenoid inferior margin, was measured on coronal magnetic resonance imaging. This shoulder image was measured to be 12.22 mm of the head elevation of humeral head.
Table 1.
Demographics of Large to Massive RCTs in Patients over 65 Years Old
Table 2.
Treatment of Large to Massive RC Tears in Patients over 65 Years Old
Table 3.
Humeral Head Decenteralization Results of Preoperative Magnetic Resonance Imaging of Large to Massive Rotator Cuff Tears in Patients over 65 Years Old
Table 4.
Clinical Results of Large to Massive Rotator Cuff Tears in Patients over 65 Years Old (Unit: Points)
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