Monday, January 7, 2013

Rotator cuff repair - age and tear retraction

Effect of age on functional and structural outcome after rotator cuff repair

Eighty-one men and 96 women with a mean age of 60.0 +/- 8.7 years had miniopen (47) or arthroscopic (130) single (59) or double row (118) rotator cuff repairs. The mean AP dimension of cuff tear at the footprint was 2.35 6 1.26 cm (range, 0.6-7.5 cm), and the mean retraction length was 2.32 6 1.12 cm (range, 0.5-5.0 cm). There were 7 small tears (<1 cm), 116 medium tears (1-3 cm), 39 large tears (3- 5 cm), and 15 massive tears (>5 cm).

An abduction brace was used for 4 weeks for small, 5 weeks for medium, and 6 to 7 weeks for large to
massive tears. Active-assisted ROM exercise was encouraged after the weaning off the brace. Muscle strengthening was started at 9 to 12 weeks postoperatively. All sports activities were permitted 6 months after the operation. Clinical and cuff integrity results by CT arthrogram were obtained at one year after surgery.

Patient age was higher in women (P .001); the nonsmoking group (P .001); the presence of biceps lesions (P <.001), higher fatty degeneration of the  cuff muscles (P <.001), larger size tear (P .001), more retraction of the tear (P <.001).

31% of the repairs were not intact at followup. Patients with retears had an average age of 63.7 +/- 7.5 while those with intact repairs had an average age of 58.4 +/- 8.7 years, (P <.001).

Univariate analysis were reported to be significant variables for the postoperative cuff integrity: symptom onset, level of sports activity, size and retraction of tear, status of the biceps, and the fatty degeneration of the supraspinatus, infraspinatus, and subscapularis, but the correlation coefficients, p values and confidence intervals are not provided. Retraction of the tear was an independent predictor of postoperative cuff integrity (p 0.011) as was fatty degeneration of the infraspinatus (p .04)

The Simple Shoulder Test scores for the entire group improved from 3 ± 3 to 8 ± 3. Age was not an independent variable of functional outcome.

This study demonstrates that age correlates with tear retraction and that tear retraction correlates with postoperative cuff integrity.

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