Steadman Philippon Research Institute, Vail, Colorado, USA.
The Steadman Clinic, Vail, Colorado, USA.
Am J Sports Med. 2020 Mar;48(3):744-753. doi: 10.1177/0363546519834574. Epub 2019 Apr 30.
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.
To systematically review the literature on the outcomes of RCR among patients ≥70 years old.
Systematic review; Level of evidence, 4.
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.
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 ( = .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.
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.
70 岁以上患者肩袖修复（RCR）的适应证和结果尚未广泛报道。 该年龄段的许多活跃患者希望选择保留关节的治疗方案，几项小系列研究报告了 70 岁以上患者 RCR 的成功临床结果。
系统回顾 70 岁以上患者 RCR 的结果。
系统回顾；证据水平，4 级。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行文献系统回顾。 使用 PubMed 和 Cochrane 电子数据库进行文献检索。 根据 Coleman 方法学评分评估纳入研究的质量。 纳入评估 70 岁以上患者全层肩袖撕裂修复的英文研究。
共回顾了 11 项研究，包括 680 例患者（694 肩）接受了关节镜和/或开放 RCR 治疗，平均随访 24.2 个月（范围，12-40.8 个月）。 40 例患者失访，654 例肩有结果数据。 该年龄组在 RCR 后临床和功能结果显著改善，满意度高。美国肩肘外科医生评分从术前的 44.2（范围，35.4-56）改善至术后的 87.9（范围，84-90.3），而 Constant 评分从术前的 41.7（范围，22.6-53.6）改善至术后的 70.8（范围，58.6-76）。对 513 例肩关节进行术后影像学评估，发现再撕裂率为 27.1%（139 例）。 开放修复后有 45 例再撕裂，关节镜修复后有 94 例。关节镜修复与开放修复的再撕裂率差异无统计学意义（=.831）。 根据视觉模拟评分，疼痛从术前的 5.5（范围，4.6-6.4）改善至术后的 1.3（范围，0.5-2.3）。
70 岁以上患者 RCR 具有较高的临床成功率，且结果良好，整体疼痛缓解效果极佳。 尽管该年龄段患者在影像学研究中有很高的再撕裂或持续缺陷的可能性，但 RCR 为适当指征的患者提供了保留关节的选择，并可显著改善功能和临床结果。
