BACKGROUND: The objective of this randomised trial was to compare surgical rotator cuffrepair to simple decompression by acromioplasty and biceps tenotomy in patients older than 60years of age with a mean follow-up of 4years. HYPOTHESIS: Tendon repair produces better functional outcomes than simple decompression and prevents progression towards cufftear arthropathy in the longer term. PATIENTS AND METHOD: Of 130 initially included patients older than 60years of age and having rotator cufftears deemed amenable to surgical repair, 103 (79%) were evaluated after a mean of 4years. These patients had been randomly allocated to acromioplasty and tenotomy (AT group, n=49) or to acromioplasty, tenotomy, and tendon suture (CR group, n=54). The tear was distal in 41 patients, intermediate in 40, and retracted in 22. At last follow-up, the evaluation included the clinical Constant's Score, radiographs and, in the CR group, ultrasonography. RESULTS: The complication rate was 4%. The mean Constant Score was 44 preoperatively; values after 4years were 76 overall (P=0.01), 78 in the CR group, and 73 in the AT group (P=0.01). The tendon-healing rate as assessed using ultrasonography was 63%. The Constant Score was significantly better when tendon healing was achieved (82/73, P<0.001). In the AT group, the acromio-humeral distance was significantly shorter (6.9mm/7.8mm, P=0.03) and eccentric humeral head position was more common (44%/26%, P=0.01). DISCUSSION: Arthroscopic rotator cuffrepair provides better functional outcomes than does simple decompression in patients older than 60years and prevents cufftear arthropathy with eccentric humeral head position in the medium term. Tendon healing is the main determinant of outcomes after rotator cuffrepair. LEVEL OF EVIDENCE: II, randomised trial.
Jacquot, A., Dezaly, C., Goetzmann, T., Roche, O., Sirveaux, F., & Molé, D. (2014). Is rotator cuffrepair appropriate in patients older than 60years of age? Prospective, randomised trial in 103 patients with a mean four-year follow-up. Orthopaedics and Traumatology: Surgery and Research, 100(6), S333–S338. https://doi.org/10.1016/j.otsr.2014.04.004