title: Rotator cuff tears after 70 years of age: a prospective, randomized, comparative study between decompression and arthroscopic repair in 154 patients.
abstract: BACKGROUND
  Arthroscopic repair of rotator cuff tears leads to better clinical outcomes than subacromial decompression alone; however the former is rarely proposed to patients above 70 years of age. Our hypothesis was that arthroscopic repair would be superior to decompression in patient 70 years 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 70 years 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 74.6 years. 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 75 years 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).
  
  
  CONCLUSIONS
  There was a significant improvement in all-clinical scores for both techniques 1 year after surgery. Repair was significantly better than decompression for all clinical outcomes, even in patients above 75 years 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.
authors.affiliation: Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges-Nègrevergne, 33700 Mérignac, France. Electronic address: phflurin@gmail.com.
authors.forename: P-H
authors.initials: PH
authors.lastname: Flurin
authors.forename: P
authors.initials: P
authors.lastname: Hardy
authors.forename: P
authors.initials: P
authors.lastname: Abadie
authors.forename: P
authors.initials: P
authors.lastname: Desmoineaux
authors.forename: J
authors.initials: J
authors.lastname: Essig
authors.forename: T
authors.initials: T
authors.lastname: Joudet
authors.forename: C
authors.initials: C
authors.lastname: Sommaire
authors.forename: C-E
authors.initials: CE
authors.lastname: Thelu
mesh_terms: D000368:Aged; D001182:Arthroscopy / Q000379:methods* / Q000534:rehabilitation; D019299:Decompression, Surgical / Q000379:methods* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D018709:Statistics, Nonparametric; D013708:Tendon Injuries / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Arthroscopy; Full-thickness tear; Rotator cuff