Two-Year Outcomes Following Arthroscopic Rotator Cuff Repair in Recreational Athletes Over 70 Years of Age

OBJECTIVES: Outcomes following arthroscopic rotator cuff repair in active individuals over 70 years old is presently unclear. The purpose of this study was to evaluate clinical outcomes and prognostic factors affecting outcomes following arthroscopic repair of full thickness rotator cuff tears in recreational athletes aged 70 years or older. METHODS: IRB approval was obtained prior to initiation of this study. Data was collected prospectively and retrospectively reviewed. From December 2005 to November 2012 44 patients (49 shoulders) that were 70 years or older who were recreational athletes and who had undergone a primary or revision arthroscopic repair of full-thickness supraspinatus tears with or without infraspinatus and subscapularis tendon involvement were identified from a surgical registry. Demographic information, surgical data, acromion-humeral distance and Goutallier classification of fatty infiltration were collected. Pre and post-operative clinical outcomes scores were collected including the American Shoulder and Elbow Surgeons’ (ASES) scores, Single Assessment Numeric Evaluation (SANE) scores, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, and Short-Form 12 Physical Component Summary (SF-12 PCS) scores. Patient satisfaction (range, 1-10,10=best) and reasons for activity modification was collected at final follow-up. RESULTS: The mean age was 73 years (range,70-82 years) in 49 shoulders (33 men,11 women,5 bilateral) with a mean acromion-humeral distance of 9.2 mm (range,3.0 -15.9 mm). Four shoulders (8%) were revision procedures of a prior rotator cuff repair. Twenty-eight shoulders (57%) had full thickness tears of two tendons and one shoulder (2%) had full thickness tears of three tendons. Twelve shoulders (25%) had osteoarthritis with Outerbridge criteria of 3 or 4. All patients had a Goutallier classification of 2 or below. No patients required revision rotator cuff surgeries; however, 1 patient had surgical treatment for stiffness. Mean follow-up was 3.6 years (range, 2.0 - 6.9 years) in 43/49 (88%) shoulders. All postoperative outcomes measures demonstrated significance when compared to their preoperative baselines. The ASES scores improved by 34.3 points from 56.0 preoperatively to 90.3 postoperatively (p<0.001) with significant improvements in both pain and function components. The SANE score improved from 63.1 to 85.1 (p=0.034), QuickDASH from 34.1 to 11.3 (p< 0.001), and SF-12 PCS from 43.0 to 51.6 (p<0.001). There was significant improvement in the impact of pain affecting ADLs (p< 0.001), recreational sporting activities (p< 0.001), and sleeping (p< 0.001). Median satisfaction was 10/10 (range,1-10). Patients who modified their recreational activities due to postoperative weakness were significantly less satisfied (6 vs 10; p=.018). In this study, 24/31 (77%) were able to return to their sport at a similar level of intensity to preinjury levels. CONCLUSION: Arthroscopic rotator cuff repair was highly effective at reducing pain, improving function and returning patients to sport in high demand elderly individuals over 70 years of age.