title: Is rotator cuff repair appropriate in patients older than 60 years of age? prospective, randomised trial in 103 patients with a mean four-year follow-up.
abstract: BACKGROUND
  The objective of this randomised trial was to compare surgical rotator cuff repair to simple decompression by acromioplasty and biceps tenotomy in patients older than 60 years of age with a mean follow-up of 4 years.
  
  
  OBJECTIVE
  Tendon repair produces better functional outcomes than simple decompression and prevents progression towards cuff tear arthropathy in the longer term.
  
  
  METHODS
  Of 130 initially included patients older than 60 years of age and having rotator cuff tears deemed amenable to surgical repair, 103 (79%) were evaluated after a mean of 4 years. These patients had been randomly allocated to acromioplasty and tenotomy (AT group, n=49) or to acromioplasty, tenotomy, and tendon suture (CR group, n=54). The tear was distal in 41 patients, intermediate in 40, and retracted in 22. At last follow-up, the evaluation included the clinical Constant's Score, radiographs and, in the CR group, ultrasonography.
  
  
  RESULTS
  The complication rate was 4%. The mean Constant Score was 44 preoperatively; values after 4 years were 76 overall (P=0.01), 78 in the CR group, and 73 in the AT group (P=0.01). The tendon-healing rate as assessed using ultrasonography was 63%. The Constant Score was significantly better when tendon healing was achieved (82/73, P<0.001). In the AT group, the acromio-humeral distance was significantly shorter (6.9 mm/7.8mm, P=0.03) and eccentric humeral head position was more common (44%/26%, P=0.01).
  
  
  CONCLUSIONS
  Arthroscopic rotator cuff repair provides better functional outcomes than does simple decompression in patients older than 60 years and prevents cuff tear arthropathy with eccentric humeral head position in the medium term. Tendon healing is the main determinant of outcomes after rotator cuff repair.
  
  
  METHODS
  II, randomised trial.
authors.affiliation: Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France. Electronic address: ad.jacquot@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Jacquot
authors.affiliation: Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
authors.forename: C
authors.initials: C
authors.lastname: Dezaly
authors.affiliation: Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
authors.forename: T
authors.initials: T
authors.lastname: Goetzmann
authors.affiliation: Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
authors.forename: O
authors.initials: O
authors.lastname: Roche
authors.affiliation: Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
authors.forename: F
authors.initials: F
authors.lastname: Sirveaux
authors.affiliation: Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
authors.forename: D
authors.initials: D
authors.lastname: Molé
mesh_terms: D000173:Acromioclavicular Joint / Q000601:surgery; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D013710:Tendons / Q000000981:diagnostic imaging / Q000601:surgery; D058971:Tenotomy / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Acromioplasty; Biceps tenotomy; Cuff tear arthropathy; Rotator cuff; Tendon healing