Monday, October 24, 2016

Rotator cuff sugery in patients over 75 years - is it worth it?

Rotator cuff surgery in patients older than 75 years with large and massive tears

These authors evaluated 64 elderly patients who underwent rotator cuff repair for large and massive rotator cuff tears. Repair was effected using a double mattress technique followed by a three month postoperative rehab program. An abduction brace was used for 7 to 8 weeks. The patients started passive forward elevation on the first postoperative day. After 4 weeks, pulley exercises to gain full forward elevation were started. Strengthening of the rotator cuff and periscapular muscle and wall pushups were started immediately after removal of the shoulder abduction brace at postoperative week 8. Posterior capsular stretching exercises and internal rotation stretching were initiated after approximately 3 months of strengthening exercises.

The mean postoperative follow-up period was 30.2 ± 5.2 months (range, 24-60 months). 80% were satisfied with their results. 26% had retears by MRI.

The authors concluded that "surgical treatment for large to massive rotator cuff tears in elderly patients with American Society of Anesthesiologists grade <4 provides good functional outcomes without morbidity, even in those with retears".

Comment: The results of patients with retears were essentially the same as those with intact repairs. The chart below compares the preoperative (pre) and postoperative (post) values for the intact and failed repairs.

It is interesting that the improvement in range of motion was better for those shoulders with failed repairs, as shown in the graph below that shows the change in the different parameters after surgery.

This study, like many before it, make us wonder about the indications and the benefit of a repair surgery with a prolonged rehabilitation program - especially in older individuals.

We find that many of these individuals are well served by a smooth and move procedure (see this link).