Arthroscopic repair of the rotator cuff: Prospective study of tendon healing after 70聽years of age in 145 patients

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• 作者：P.-H. Flurin ; P. Hardy ; P. Abadie ; P. Boileau ; P. Collin ; J. Deranlot ; P. Desmoineaux ; M. Duport ; J. Essig ; A. Goden猫che ; T. Joudet ; J. Kany ; C. Sommaire ; C.-E. Thelu ; P. Valenti ; the French Arthroscopy Society (SFA)
• 关键词：Shoulder ; Arthroscopy ; Full-thickness tear ; Rotator cuff healing
• 刊名：Orthopaedics Traumatology: Surgery Research
• 出版年：December, 2013
• 年：2013
• 卷：99
• 期：8_supp_S
• 页码：S379-S384
• 全文大小：921 K

文摘

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Summary

Introduction

The level of activity of patients older than 70聽years is tending to increase, as are their expectations in terms of joint function recuperation. It has not been proven that rotator cuff repair healing is satisfactory in the elderly. The main hypothesis of this study was: repair of supraspinous lesions in patients older than 70聽years is reliable in terms of both clinical results and healing. The secondary hypothesis was: tendon healing is significantly correlated with the Constant, ASES, and SST scores as well as with age, tendon retraction, and fatty infiltration.

Material and methods

Multicenter prospective study on 145 patients older than 70聽years, with 135 patients reviewed at 1聽year (93%). The mean age was 73.9聽years. Full-thickness tears of the supraspinatus extended at most to the upper third of the infraspinatus and retraction limited to Patte stages 1 and 2 were included. Clinical assessment was carried out in accordance with the Constant, ASES, and SST scores. Healing was evaluated with ultrasound.

Results

A significant improvement was noted in the Constant (44/76) +31.5 (m>Pm> < 0.0001), ASES (35/90) +54.4 (m>Pm> < 0.0001), and SST (3.5/10) +6.6 (m>Pm> > 0.0001) scores at 1聽year of follow-up. The healing rate was 89% with 15 re-tears, nine of which were stage 1 and six stage 2. The clinical result was not correlated with patient age (Constant, m>Pm> = 0.24; ASES, m>Pm> = 0.38; SST, m>Pm> = 0.83) nor with the retraction stage (Constant, m>Pm> = 0.71; ASES, m>Pm> = 0.35; SST, m>Pm> = 0.69) or the stage of fatty infiltration (m>Pm> > 0.7). Healing was correlated with the quality of the clinical result (Constant, m>Pm> = 0.02; ASES, m>Pm> = 0.03) and age (m>Pm> = 0.01) but was not correlated with retraction or the fatty infiltration stage (m>Pm> > 0.3).

Discussion/conclusion

Arthroscopic repair significantly improves the clinical results, even in patients older than 70聽years. The clinical results are not correlated with age (but deterioration of the result was not noted after 75聽years) or frontal retraction (but the study only included retractions limited to stages 1 and 2). The healing rate is satisfactory, but this study is limited to small ruptures of the supraspinatus, and the postoperative ultrasound analysis probably inferior to CT imaging with contrast agent injection, often used as the reference. Healing proves to be correlated with the quality of the clinical result and patient age.