Abstract
Objectives:
Massive rotator cuff tears (MRCTs) are a frequent and challenging entity encountered by for orthopedic surgeons, accounting for up to 40% of all rotator cuff tears (RCT). Furthermore, the efficacy of repair of MRCTs in older patients is questioned by some. The purpose of this study is to report minimum 5-year outcomes after primary arthroscopic rotator cuff repair (ARCR) of MRCT and the effect that age has on outcomes. We hypothesized that there would be low rates of revision and a high patient satisfaction in a mid-term follow up in those patients treated with a primary ARCR independent of age.
Methods:
Data was collected prospectively and retrospectively reviewed for this IRB approved study. Inclusion criteria was that patients were a minimum of 5 years out from an ARCR of a MRCT by a single surgeon from February 2006 to November 2016. Patients were excluded if they had glenohumeral osteoarthritis (Hamada >2), fatty infiltration (Goutallier >3), or if they had concomitant pathologies such as labral lesions or chondromalacia that led to additional surgical procedures except for biceps tenodesis/tenotomy and subacromial decompression. MRCTs were defined by the Neer Circle’s Delphi consensus statement as tendon retraction to the glenoid rim and/or a minimum exposed greater tuberosity of at least 67 percent in combination with the Gerber classification of at least two affected tendons. Patient reported outcome (PRO) data was collected preoperatively and evaluated at a minimum follow-up of 5 years postoperatively using the American Shoulder and Elbow Surgeons Score (ASES), Single Assessment Numeric Evaluation Score (SANE), Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH), the Short Form 12 physical component summary (SF-12 PCS), and patient satisfaction to assess surgical outcomes at final follow-up. Linear and LOESS regression in addition to correlation was analyzed to assess the effect of age on clinical outcomes. Further, a sub-group analysis of patients over and under 65 was performed. Retears, revision surgery, and surgical complications were recorded. Surgical failure was defined as revision surgery.
Results:
In total, 188 patients with ≥ 2 tendon RCTs who were at least 5 years out from surgery were identified. After application of exclusion criteria and the Neer Circle’s MRCT definition, 61 patients (mean age: 59.5 years, range: 39.6-73.8; 38 males, 23 females) with a mean follow up of 7.9 years (range 5.0-12.1) included in this study. Final follow-up was obtained in 44 patients (76%). At final follow-up, the mean PROs were significantly improved over preoperative levels for all PROs. The ASES scores improved from 59.4 to 95.0 (p<.001), SANE improved from 66.3 to 89.9 (p>.001), QuickDASH improved from 34.2 to 8.3 (p<.001) and SF-12 PCS improved from 41.5 to 51.3 (p<.001). Median postoperative satisfaction was 10 (range 1-10). Linear and LOESS regression analysis as well as correlation analysis showed that no PRO measures (ASES, SANE, QuickDASH, SF12-PCS, or patient satisfaction) were significantly associated with age at time of surgery. In the subgroup analysis of over and under 65, no significant differences between groups were demonstrated for PROs with the exception of postoperative SF-12 PCS (53.6 vs. 49.1; p=.041).
Conclusions:
The most important finding in this study is that patients undergoing ARCR of MRCTs experience significant improvements in shoulder function irrespective of patient age.