Arthroscopic Rotator Cuff Repair in a Geriatric Population: Is it Worthwhile?

Introduction: Optimal treatment for symptomatic rotator cuff (RC) tears in the geriatric population remains unclear.

Objectives: Ascertain whether arthroscopic repair is safe and effective for treating symptomatic RC tears in over 75s.

Methods: The study comprised 60 shoulders in 59 patients aged over 75 who underwent arthroscopic RC repair from 2006-2014. Outcome scores collected prospectively were Constant score (CS), pain and satisfaction. Data collected included operative complications and demographics. Mean follow-up was 20 months.

Results: Mean age was 78. Tear sizes were 25 massive, 20 large, 12 medium and 3 small. Mean preoperative CS was 38.5 (adjusted 55.5) compared to 63.5 (adjusted 91.6) postoperatively (P<0.0001). No difference was seen in males versus females (p=0.769), age >80 versus age 75-79 (p=0.303) or active versus sedentary patients (p=0.556). However massive tears showed lower mean CS of 54.7 (adjusted 76.3) compared to 70.5 (adjusted 102.3) for other patients (p=0.0007). Postoperatively mean Pain Score was 2.3/15 and Satisfaction Score was 7.9/10. These scores were slightly lower for the massive repair group (p=0.007 and p=0.002 respectively). Surgical complications were one infection and one stiff shoulder. Four patients had subsequent rTSA at a mean of 28 months after cuff repair. Massive tears had higher risk for subsequent rTSA (p=0.026).

Conclusions: Arthroscopic RC provides a safe and effective solution for symptomatic cuff tears in over 75s. 55/59 patients were satisfied with their shoulders and resumed their previous activities including sport. There was no difference between males, females, over 80s, ages 75-79, active and sedentary patients. Even patients with massive tears showed clinically significant improvements following arthroscopic RC repair, although to a lesser degree. We should remember that there is a selection bias as the senior author considered these patients suitable for repair. Arthroscopic RC repair in over 75s should be considered as a valuable treatment according to biological, rather than chronological age.