Rotator cuff tears after 70 years of age: A prospective, randomized, comparative study between decompression and arthroscopic repair in 154 patients - 05/12/13
, P. Hardy b, P. Abadie a, P. Desmoineaux c, J. Essig d, T. Joudet e, C. Sommaire f, C.-E. Thelu gthe
French Arthroscopy Society (SFA)h
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
Summary |
Introduction |
Arthroscopic repair of rotator cuff tears leads to better clinical outcomes than subacromial decompression alone; however the former is rarely proposed to patients above 70years of age. Our hypothesis was that arthroscopic repair would be superior to decompression in patient 70years or older. 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.
Methods |
This was a prospective, comparative, randomized, multicenter study where 154 patients were included who were at least 70years of age. Of the included patients, 143 (70 repair and 73 decompression) were seen at one-year follow-up; these patients had an average age of 74.6years. 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 with 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; arthroscopic repair was also better in patients above 75years of age (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 stages 0 and 1 fatty infiltration (Constant P<0.02) than in patients with stages 2 and 3 fatty infiltration (Constant P<0.05).
Conclusion |
There was a significant improvement in all-clinical scores for both techniques 1year after surgery. Repair was significantly better than decompression for all clinical outcomes, even in patients above 75years 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.
Level of proof |
II (prospective, randomized study with low power).
Le texte complet de cet article est disponible en PDF.Keywords : Arthroscopy, Full-thickness tear, Rotator cuff
Plan
Vol 99 - N° 8S
P. S371-S378 - décembre 2013 Retour au numéro
Article précédent
- A new instrument to measure the activity profile of elderly shoulder pathology patients: The Senior Shoulder Activity score (SSA score)
- J. Deranlot, P.-H. Flurin, P. Hardy, S. Klouche, French Arthroscopy Society (SFA) c
- Arthroscopic repair of the rotator cuff: Prospective study of tendon healing after 70 years of age in 145 patients
- P.-H. Flurin, P. Hardy, P. Abadie, P. Boileau, P. Collin, J. Deranlot, P. Desmoineaux, M. Duport, J. Essig, A. Godenèche, T. Joudet, J. Kany, C. Sommaire, C.-E. Thelu, P. Valenti, the French Arthroscopy Society (SFA) l
Bienvenue sur EM-consulte, la référence des professionnels de santé.