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Age May Not Be Linked with Results of Rotator Cuff Repair After All
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Posted on: 11/30/1999
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The older we get, the more things can go wrong with the body. Rotator cuff tears in the shoulder is one of those problems that seems to go hand-in-hand with the aging process. The rotator cuff is a group of four muscles, tendons, and the connective tissue covering them that surround the shoulder joint. The cuff helps keep the shoulder in the socket as well as moves the shoulder in all directions.
If aging affects the rotator cuff, what's the effect of older age on recovery after surgery to repair a rotator cuff tear? Is it always true that age is a risk factor for a poor healing and less than optimal outcomes after surgery? Surgeons from the Seoul National University College of Medicine in Korea say, No.
They studied 177 older adults (ages) who had a rotator cuff repair to see how age was related to results. Only adults with full-thickness rotator cuff tears (and no previous or other shoulder injuries or damage) were included. One surgeon performed all of the procedures. Specifics of surgical techniques used are provided in this article.
A great deal of data was collected on each patient because the authors were looking for the relationship between age and outcomes as well as any factors that might be connected with age and outcome. Some of the additional information gathered and analyzed for each patient included sex, activity level, tobacco use, how long the symptoms had been present, range-of-motion for the affected shoulder, arm dominance (right-handed versus left-handed), and type of work (manual labor versus sedentary work).
Imaging such as MRIs and CT scans were used to take a closer look at the rotator cuff. These studies gave the surgeons an idea of how badly damaged the tendons were and how much of the torn area filled in with fatty or scar tissue. The concept of fat filling in where the tendon is damaged is called fatty degeneration. The same images were repeated one year after surgery to show where the rotator cuff had been reattached, an area called the footprint. The integrity of the footprint was evaluated.
Strength was tested using a special machine called a Biodex. Additional tests were done to rate the patients' pain and function before and after and to measure patient satisfaction after surgery. Any complications such as infection, fracture, damage to the blood vessels or nerves, and shoulder stiffness were recorded for each patient.
There were differences in patient characteristics based on age -- for example, the oldest patients were women, nonsmokers, and very low (sedentary) in their activity level. But the overall results didn't vary among the various age groups. The main difference in results was really linked more to how much the torn tendon had retracted (pulled away from the bone) and the amount of fatty degeneration present between the retracted tendon and bone.
Age was linked with the risk of a retear, though. One-third of the group (all older adults) experienced a retear of the surgically repaired rotator cuff. Turns out age wasn't as much of a factor in these retears as the type of sutures used (metal or bioabsorbable) and the type of surgical approach (mini-open versus all arthroscopic).
The authors report there are other studies that say, Yes age is a factor, while still others show mixed results. They maintain that the way the factors are analyzed makes a difference. In this study, they used a method of analysis called multivariate regression. Most other studies used univariate regressionanalysis.
The difference in how the data is analyzed makes a difference in whether it looks like age is a direct (independent) factor or not. Univariate analysis shows older age is related to poor results; multivariate not only shows age isn't an independent factor, it also allows the researchers to find out what factors really are the missing link. In this case, it was tendon retraction and fatty degeneration. That's a new twist in this argument that will bear further study and discussion.
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References:
Joo Han Oh, MD, PhD, et al. Effect of Age on Functional and Structural Outcome After Rotator Cuff Repair. In The American Journal of Sports Medicine. April 2010. Vol. 38. No. 4. Pp. 672-678.
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