Arthroscopic Full-Thickness Rotator Cuff Repair in Elderly Patients

Sang Jin Cheon; Dong Ho Lee; Yong Geon Park; Seung Min Son

doi:10.4055/jkoa.2020.55.1.38

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Cheon, Lee, Park, and Son: Arthroscopic Full-Thickness Rotator Cuff Repair in Elderly Patients

Original Article

Journal of the Korean Orthopaedic Association 2020; 55(1): 38-45.

Published online: 12 February 2020

DOI: https://doi.org/10.4055/jkoa.2020.55.1.38

Arthroscopic Full-Thickness Rotator Cuff Repair in Elderly Patients

Sang Jin Cheon, M.D.

, Dong Ho Lee, M.D.^*

, Yong Geon Park, M.D.

, Seung Min Son, M.D.^†

Department of Orthopaedic Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

^*Department of Orthopaedic Surgery, Barun Hospital, Busan, Korea.

^†Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.

Correspondence to: Sang Jin Cheon, M.D. Department of Orthopaedic Surgery, Pusan National University Hospital, 179 Gudeok-ro, Seogu, Busan 49241, Korea. TEL: +82-51-240-7531 FAX: +82-51-247-8395, scheon@pusan.ac.kr

Received 8 September 2019 Revised 29 October 2019 Accepted 23 December 2019

The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To examine the clinical and structural outcomes of an at least two-year follow-up of arthroscopic full-thickness rotator cuff repairs with a single-row or suture-bridge technique in patients more than 65 years of age.

Materials and Methods

Patients diagnosed with a full-thickness rotator cuff tear who were more than 65 years of age, underwent arthroscopic rotator cuff repair after at least six months of conservative treatment, agreed to take a follow-up magnetic resonance imaging (MRI) six months postoperatively, and visited outpatient for at least two years were enrolled in this study. Clinical evaluations were done using The University of California Los Angeles score, Constant Shoulder Score, and visual analogue scale evaluated two years after the surgery. The structural integrity was analyzed using follow-up MRI. During surgery, a suture-bridge technique was used if the rotator cuff tendon could cover half of the footprint under constant tension. Otherwise, single-row repair was performed.

Results

The samples were 158 cases, consisting of 93 single-repairs and 65 suture-bridge repairs. A preoperative comparison of the age distribution, fatty degeneration of supraspinatus and infraspinatus muscle, medial retraction of torn cuff tendon, and tear size between the two groups were not significant. The clinical scores were improved significantly in all cases. The distribution of the structural integrity by Sugaya classification were 49 cases in type 1 (31.0%), 62 cases in type 2 (39.2%), 30 cases in type 3 (19.0%), 11 cases in type 4 (7.0%), and six cases in type 5 (3.8%). The re-tear rate of the single-row group was 9.7% (nine out of 93 cases) and 12.3% (eight out of 65 cases) for the suture-bridge group.

Conclusion

Satisfactory clinical and radiological outcomes were achieved after arthroscopic full-thickness rotator cuff repair in patients more than 65 years of age. Both single-row and suture-bridge techniques would be beneficial for the elderly.

Keywords: full-thickness rotator cuff tear, more than 65 years of age, single-row repair, suture-bridge repair

Figures and Tables

Table 1

Patient Demographics (n=158)

Values are presented as mean±standard deviation or range. ^*Ratios displayed are in percentage. SSp, supraspinatus; ISp, infraspinatus; S, small tear (<1 cm); M, medium tear (1–3 cm); L, large tear (3–5 cm); XL, massive tear (>5 cm), -, not available.

Table 2

Clinical Outcomes of Total Cases

Values are presented as mean±standard deviation. UCLA, University of California Los Angeles; CSS, Constant Shoulder Score; VAS, visual analogue scale.

Table 3

Clinical Outcomes Comparison between the Two Groups

Values are presented as mean±standard deviation. SR, single-row repair group; SB, suture-bridge repair group; UCLA, University of California Los Angeles; CSS, Constant Shoulder Score; VAS, visual analogue scale.

Table 4

Postoperative Distribution of Structural Integrity Types Refer to Sugaya's Classification

Values are presented as number (%). SR, single-row repair group; SB, suture-bridge repair group.

Notes

This work was supported by a 2-year Research Grant of Pusan National University.

^{CONFLICTS OF INTEREST} The authors have nothing to disclose

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ORCID iDs

Sang Jin Cheon
https://orcid.org/0000-0002-5544-7155

Dong Ho Lee
https://orcid.org/0000-0003-4422-6151

Yong Geon Park
https://orcid.org/0000-0002-1660-7443

Seung Min Son
https://orcid.org/0000-0001-6977-6139

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