Repair of Rotator Cuff Tears in the Elderly: Does It Make Sense? A Systematic Review - Matthew Provencher, MD | Orthopedic Knee & Shoulder Surgeon

Authors:

Burak Altintas, Nicole L Anderson, Rafael Pitta, Patrick S Buckley, Sanjeev Bhatia, Matthew T Provencher, Peter J Millett

Abstract:

Background: The indications and outcomes for rotator cuff repair (RCR) among patients ≥70 years old are not widely reported. Many active patients in this age range desire a joint-preserving option, and several small series reported successful clinical outcomes after RCR among patients aged ≥70 years.

Purpose: To systematically review the literature on the outcomes of RCR among patients ≥70 years old.

Study design: Systematic review; Level of evidence, 4.

Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The electronic databases of PubMed and Cochrane were used for the literature search. The quality of the included studies was evaluated according to the Coleman Methodology Score. Studies in English evaluating repair of full-thickness rotator cuff tears among patients aged ≥70 years were included.

Results: Eleven studies were reviewed, including 680 patients (694 shoulders) who were treated with arthroscopic and/or open RCR with a mean follow-up of 24.2 months (range, 12-40.8 months). Forty patients were lost to follow-up, leaving 654 shoulders with outcome data. This age group demonstrated a significant increase in clinical and functional outcomes after RCR with high satisfaction. American Shoulder and Elbow Surgeons scores showed an improvement from 44.2 (range, 35.4-56) preoperatively to 87.9 (range, 84-90.3) postoperatively, while Constant scores improved from 41.7 (range, 22.6-53.6) to 70.8 (range, 58.6-76). Postoperative imaging evaluation was performed on 513 shoulders, revealing a retear rate of 27.1% (139 shoulders). There were 45 retears after open repair and 94 after arthroscopic repair. The difference in retear rate among patients receiving arthroscopic repairs was not significantly different than open repairs (P = .831). Pain according to a visual analog scale improved from 5.5 (range, 4.6-6.4) preoperatively to 1.3 (range, 0.5-2.3) postoperatively.

Conclusion: RCR among patients ≥70 years old shows high clinical success rates with good outcomes and overall excellent pain relief. Although patients in this age group have a high potential for retear or persistent defects on imaging studies, RCR offers a joint-preserving option with significant functional and clinical improvement for the appropriately indicated patient.

For the complete study: Repair of Rotator Cuff Tears in the Elderly: Does It Make Sense? A Systematic Review

Matthew Provencher, MD

Average rating:

66 reviews

James Wilson

Oct 11, 2024

by James Wilson on Matthew Provencher, MD

Senior Electronics development engineer

Wow the Steadman clinic and Doctor Matthew Provencher now that;s a super combination of expertise, experience, empathy, skill and a cherry picked staff with truly outstanding nurses and professional support staff. I was scared of shoulder surgery until I read Dr. Provencher BIO and talked to him. If your considering shoulder replacement surgery this is the place. In three weeks out now and people are amazed at my ability of movement and flexibility I have now. I love the Steadman Clinic and Dr. Matthew Provencher, He's Superman

Anne Miller

Jun 18, 2024

by Anne Miller on Matthew Provencher, MD

Grateful to Dr Provencher and his team

I am a 75-year old, active, athletic woman. Over the last few years, both of my shoulders reached a point where severe arthritis was affecting even day to day tasks. It started with one shoulder in 2021 and recently the second reverse shoulder replacement – both with Dr Provencher. Before my first one, I had received various recommendations including adjusting my lifestyle. Dr Provencher looked at my MRI and x-ray and asked what I enjoy doing and was quick to let me know I could be back to my active lifestyle soon – and he was right. He reads images faster and more accurately than any doctor I have consulted. He has many options available and if you need surgery he is the one to do it. Surgery is quick and the recovery is much easier than I anticipated. I am 10 days out from my second reverse shoulder and have no pain and gaining mobility already! My case for both shoulders was a bit more complicated due to bone integrity, severe arthritis and bicep tears. Dr Provencher has dealt innovatively with both complications and makes it seem straightforward although I know it was not. He is not only one an extraordinary surgeon, but also, a caring human being who takes the time with his patients and makes himself available if questions arise. His team is second to none – Maddy, Madison, Sam, Scott, Jasmin and in pre-op, Layla and Kevin – in terms of commitment, competence, compassion and responsiveness. Both times I have felt cared for and that resolving my situation mattered to him. Wherever you live, Dr Provencher and his team are the ones to trust. There is no need to live a compromised life!

Gene reiling

Jul 21, 2023

by Gene reiling on Matthew Provencher, MD

Success

If you are planning to see Dr Provencher ,do not hesitate ,do it. In 2018 Dr Provencher replaced my LCL. I had no complications and very little pain. I did my physical therapy as prescribed. I was able to ski 30 plus days the winter of 2019-2020. Before seeing dr Provencher I had spent a years time trying to solve my problem locally. I saw a pain specialist, orthopedic urgent care and a orthopedic surgeon. All had access to an mri done locally. It was also read by local radiologist. Pain dr gave injections as did orthopedic urgent care. No relief from pain. Orthopedic surgeon told me about arthritis, meniscus needing cleaning up and general deterioration from age. Told me to take ibuprofen for pain. At that time I reached out to Steadman Clinic. By luck of the draw I was assigned Dr Provencher. I took with me the mri that had been done locally and viewed by 3 local Drs and 1 PA. It took Dr Provencher less than a minute to tell me my problem was my LCL after viewing my mri. He told me my options . I selected surgery as I wanted to continue an active life style. It was a complete success!!

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