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Entries in rotator cuff (2)

Thursday
Jan312013

Rotator cuff repair in patients over 70 years of age 

Bone Joint J 2013;95-B:199–205.

P. M. Robinson, MBChB(Hons), BMedSci, MRCS(Eng), Specialty Registrar Trauma and Orthopaedics
J. Wilson, MRCSEd, MSc, Specialty Registrar Trauma and Orthopaedics
S. Dalal, FRCSEd(Tr & Orth), Consultant Orthopaedic Surgeon
R. A. Parker, BSc, MSc, Medical Statistician
P. Norburn, MBChB, MRCP, FRCR, Consultant Radiologist and
B. R. Roy, MSc (Bioeng), FRCS(Tr & Orth), DMI, Consultant Orthopaedic Surgeon

This study reports the clinical and sonographic outcome of arthroscopic rotator cuff repair in patients aged ≥ 70 years and aimed to determine factors associated with re-tear. A total of 69 consecutive repairs were performed in 68 patients with a mean age of 77 years (70 to 86). Constant-Murley scores were collected pre-operatively and at one year post-operatively. The integrity of the repair was assessed using ultrasound. Re-tear was detected in 20 of 62 patients (32%) assessed with ultrasound. Age at operation was significantly associated with re-tear free survival (p = 0.016). The mean pre-operative Constant score was 23 (sd 14), which increased to 58 (sd 20) at one year post-operatively (paired t-test, p < 0.001). Male gender was significantly associated with a higher score at one year (p = 0.019).

We conclude that arthroscopic rotator cuff repair in patients aged ≥ 70 years is a successful procedure. The gender and age of the patient are important factors to consider when planning management.

Thursday
Jul292010

THE NOTTINGHAM AUGMENTATION DEVICE: AN ALTERNATIVE APPROACH TO THE MANAGEMENT OF MASSIVE ROTATOR CUFF TEARS?

R. Jeevan; B. Roy; L. Neumann; and W.A. Wallace

Nottingham Shoulder & Elbow Institute, City Hospital, Nottingham, U.K.

Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue SUPP_II, 359.  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery

 

We aimed to test the biomechanically predicted hypothesis that in massive rotator cuff tears irreparable by conventional methods the newly developed Nottingham Augmentation Device (NAD) would provide greater functional improvement than that gained from the gold standard of arthroscopic subacromial decompression. Thirty patients treated between 2001 and 2004 were assessed by pre- and six month post-operative Constant scoring. Fifteen underwent open acromioplasty and cuff reconstruction using the NAD (mean age 67.3), while 15 underwent a standard arthroscopic decompression (mean age 67.4). The two groups were matched retrospectively based on size of cuff tear, age and sex. Data was analysed using the student’s t-test at the 95% confidence interval. Both groups displayed a statistically significant increase in Constant score after surgery. The mean increase for NAD patients was 18.7 points compared with 17.6 points for those undergoing arthroscopic decompression. However there was no significant difference between the two groups’ improvement and this was even so in the power sub-category, where increased benefit was predicted with the NAD. The NAD requires greater surgical access, operating time and peri-operative analgesia, and no active mobilisation for six weeks. The arthroscopic technique is minimal access, rapid, involves no prosthesis or foreign body insertion and allows immediate mobilisation. However, with clear biomechanical benefits of the NAD seen in vitro, our results may simply reflect cuff tears in an older population group with irreversible tissue changes and less rehabilitative potential. A randomised prospective trial in a younger patient group with more acute tears and less tissue atrophy would appear the next step in determining the NAD’s place in the management of massive rotator cuff tears.