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

BackgroundThe 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.HypothesisTendon repair produces better functional outcomes than simple decompression and prevents progression towards cuff tear arthropathy in the longer term.Patients and methodOf 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.ResultsThe 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/7.8 mm, P = 0.03) and eccentric humeral head position was more common (44%/26%, P = 0.01).DiscussionArthroscopic 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.Level of evidenceII, randomised trial.