Hawkins award 2023: clinical outcome and tendon healing after arthroscopic repair of isolated supraspinatus tears: a retrospective comparative study in patients older than 70 years vs. patients younger than 50 years

Abstract

BackgroundThe purpose of this study was to evaluate and compare the clinical and structural outcomes after arthroscopic repair of isolated supraspinatus tears in patients older than 70 years versus patients younger than 50 years in order to determine whether age influences the treatment of these tears. MethodsWe conducted a retrospective, comparative study of 87 shoulders of 86 patients older than 70 years who underwent rotator cuff repair after isolated full-thickness supraspinatus tear between January 2010 and December 2020. A control group of 87 patients younger than 50 years was matched for sex, BMI, smoking habits, tendon retraction according to Patte and fatty infiltration according to Goutallier. Clinical assessment used Constant and Murley Score (CMS), age- and sex-matched Constant scores and Subjective Shoulder Value (SSV) at 6 months. Cuff integrity was evaluated using ultrasonography based on the Sugaya criteria, types I-II-III being considered as healed. ResultsThe CMS significantly improved by +17,91 points in elderly patients compared with +7,47 points in controls (p < 0,01) and activity (p = 0,02), mobility (p < 0,01) and strength (p < 0,01). The ajusted CMS significantly improved by +24,94 in elderly patients compared with +8,49 points in controls (p < 0,01). The SSV improved by +29,48 points in elderly patients compared with +23,47 points in controls. The improvement was similar in both groups. (p < 0,10). Satisfaction was similar in both groups (p = 0,31). Regarding structural outcomes, patients younger than 50 years old presented better results in terms of healing than 70 years older patients, as the healing rate was 73,7% in the ederly group and 88,5% in the control group (p = 0,01). The clinical outcomes were not significantly associated with the tendon healing (p = 0,01). ConclusionsFunctional gain for patients older than 70 years is better than their younger peers despite their low-grade healing. Arthroscopic repair after isolated supraspinatus tears should be considered as a valuable treatment regardless the age.