Surgical Treatment of Rotator Cuff Tears After 65 Years of Age: A Systematic Review.

Abstract

The objective of this study was to analyze current evidence regarding surgical management of rotator cuff tears in patientsof 65 years of age and above. Our hypothesis was that surgical repair of rotator cuff tears, in patients older than 65 years, conveysgood outcome scores. We have not found a similar systematic review in current literature. Medline®, PubMed, Scopus, and the Cochrane Register of Controlled Trials were searched from January 1999unto December 2015 for studies, regardless of language, including the words 'rotator cuff' and '65 years' or '70 years'. Inclusion criteriawere studies (level I to IV) that reported clinical outcomes in patients older than 65 years, having undertaken surgical repair of a symptomaticrotator cuff tears. Arthroscopic, mini open and open techniques were included. Exclusion criteria were: studies with patientsyounger than 65 years, studies that did not use validated outcome evaluation scores as primary assessment tools and those with followup under one year. This work followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA guidelines.Data abstracted included patient demographics, tear pattern, surgical procedures, clinical and repair results. Outcome scores wereconverted to percentages, allowing comparison of data between studies. After deep analysis, 14 studies met the inclusion criteria: 11 level IV studies, 1 level III study and 2 level II studies. Sevenstudies found statistically significant outcome improvements between pre and postoperative evaluations. All studies reported good orexcellent surgical outcomes. Better results would probably be achieved if all studies had rigorous and homogeneous patient selection criteria, but thefact is, that even though this was not the case, the clinical scores remained favorable, and with statistically significant outcome improvementin all studies with prospectively collected data. Based on current literature, rotator cuff repair in patients older than 65 years imparts favorable improvement in clinicaloutcome scores and overall patient satisfaction.