Skip to main content

Advertisement

SpringerLink
Log in

Vergleich der funktionellen Ergebnisse nach Rekonstruktion der Rotatorenmanschette bei Patienten vor und ab der 6. Lebensdekade

Comparison of the functional results after rotator cuff repair in patients below and above 60 years of age

  • ORIGINALARBEIT
  • Published:
Obere Extremität Aims and scope Submit manuscript

Summary

Aim

The patient’s age has been described as one factor having a large influence on the success of rotator cuff surgery. With this retrospective study the relevance of the patient’s age (below 60 compared to 60 and older) on the functional and structural outcome of open rotator cuff repairs and the difference in defect size, affections of the acromioclavicular joint (ACJ) and the long head of biceps (LHB) was analysed.

Method

Group 1 consisted of 76 patients, 60 years and older (60–78 years), while group 2 of 166 patients below 60 years,who were reassessed after a minimum follow-up of 2 years after open rotator cuff repair. Intraoperatively the tear size, affections of the ACJ and LHB were recorded. The postoperative examination protocol included clinical and sonographical assessment and the evaluation of the Constant score.

Results

Regarding tear size (p=0.591), complete LHB ruptures (p=0.61) and re-tears verified by follow-up ultrasonography (p=0341) no significant differences were found. The age- and gender-adapted Constant score of group 1 (90 %) was significantly (p=0.002) better than in group 2 (81.1 %). In group 1 the ACJ (p<0.001) and LHB (p=0.002) were found to have a significantly higher rate of relevant pathologic changes.

Conclusion

Our data demonstrate no significant differences regarding the tear-size, LHB-ruptures or postoperative rate of re-tears between both groups. But the average age and gender adapted Constant-score in patients 60 years and older was significantly higher than in patients below 60 years. Therefore the age of a patients should not be the main criterion to determine the therapy for patients with rotator cuff tears. As the ACG and LHB had a significantly higher rate of relevant pathologies with increasing age, a sorrow pre- and intraoperative assessmenr is mandatory.

Zusammenfassung

Studienziel

Die zunehmende Inzidenz von Rotatorenmanschettendefekten (RMD) mit steigendem Alter stellt den Schulterchirurgen immer häufiger vor die Entscheidung, ob denn auch beim älteren Patienten eine Rekonstruktion sinnvoll und zu empfehlen ist. Anhand einer retrospektiven Analyse soll die Frage geklärt werden, inwieweit sich die klinischen Ergebnisse nach offener Rekonstruktion eines RMD, die Defektgröße, Begleitpathologien und Redefektrate bei Patienten ab dem sechzigsten Lebensjahr von denen jüngerer Patienten unterscheiden.

Methode

Bei 76 Patienten mit einem Durchschnittsalter von 65 Jahren (60–78 Jahre) und bei 166 Patienten unter 60 Jahren wurde eine Rekonstruktion eines Rotatorenmanschettendefektes durchgeführt. Es erfolgte eine genaue Analyse aller intraoperativ erhobenen Befunde hinsichtlich der Rupturgröße, Affektionen des Acromioclavicular-Gelenks (ACG) und der langen Bizepssehne (LBS). Nach einem Follow-up von mindestens 2 Jahren wurde der Constant-Score erhoben sowie eine klinische und sonographische Nachuntersuchung durchgeführt.

Ergebnisse

Die beiden Gruppen unterschieden sich hinsichtlich der intraoperativ gefundenen Rupturgröße (p=0,591) und der Häufigkeit kompletter LBS-Rupturen (p=0,61) sowie der Häufigkeit der sonographisch gefundenen Redefekte (p=0,341) nicht signifikant. Jedoch hatten die Patienten ab 60 Jahren mit einem durchschnittlichen alters- und geschlechtskorrigierten Constant-Score von 90% (13–126%) signifikant bessere Werte (p=0,002) als die Gruppe unter 60 Jahren mit 81,1% (15–116%). Bei den Patienten ab 60 fanden sich signifikant häufiger therapierelevante Affektionen des ACG (p<0,001) und der LBS (p=0,002).

Schlussfolgerung

Diese Daten zeigen für beide Gruppen keine signifikanten Unterschiede der Defektgröße, LBS-Rupturen und der Rate an Rezidivdefekten. Das ACG und die LBS waren mit zunehmendem Alter signifikant häufiger betroffen. Überraschenderweise war der Constant-Score bei den älteren Patienten signifikant besser. Diese Ergebnisse zeigen, dass eine Rekonstruktion der Rotatorenmanschette auch bei älteren Patienten gute Ergebnisse liefert und daher ein höheres Lebensalter keine Kontraindikation zur OP darstellen sollte. Bereits im Vorfeld sollte ein besonderes Augenmerk auf das ACG und die LBS gerichtet werden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatur

  1. Apreleva M, Ozbaydar M, Fitzgibbons PG, Warner JJ (2002) Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area. Arthroscopy 18:519–526

    Article  PubMed  Google Scholar 

  2. Bigliani LU, Cordasco FA, McIlveen SJ, Musso ES (1992) Operative repair of massive rotator cuff tears: Long-term results. J Shoulder Elbow Surg 1:120–130

    Google Scholar 

  3. Boehm TD (2002) Scores. In: Gohlke F, Hedtmann A (Hrsg.). Die Schulter. Thieme, Stuttgart, S. 98–104

  4. Boehm TD, Ilg A, Werner A, Kirschner S, Gohlke F (2004) Long-term results (5–13 years) of surgical repair and delta muscle flap of massive rotator cuff tears. Z Orthop Ihre Grenzgeb 142:228–234

    Article  PubMed  CAS  Google Scholar 

  5. Boehm TD, Kirschner S, Mueller T, Sauer U, Gohlke FE (2005) Dynamic ultrasonography of rotator cuff muscles. J Clin Ultrasound 33:207–213

    Article  PubMed  Google Scholar 

  6. Boehm TD, Werner A, Radtke S, Mueller T, Kirschner S, Gohlke F (2005) The effect of suture materials and techniques on the outcome of repair of the rotator cuff: a prospective, randomised study. J Bone Joint Surg Br 87:819–823

    Article  PubMed  CAS  Google Scholar 

  7. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 87:1229–1240

    Article  PubMed  Google Scholar 

  8. Cammerer U, Habermeyer P, Plenk A, Huber R (1992) Ultrasound assessment of reconstructed rotator cuffs. Unfallchirurg 95:608–612

    PubMed  CAS  Google Scholar 

  9. Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM (2001) Surgical repair of chronic rotator cuff tears. A prospective long-term study. J Bone Joint Surg Am 83-A:71–77

    PubMed  CAS  Google Scholar 

  10. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop 214:160–164

    PubMed  Google Scholar 

  11. Fuchs B, Gilbart MK, Hodler J, Gerber C (2006) Clinical and structural results of open repair of an isolated one-tendon tear of the rotator cuff. J Bone Joint Surg Am 88:309–316

    Article  PubMed  Google Scholar 

  12. Galatz LM, Griggs S, Cameron BD, Iannotti JP (2001) Prospective longitudinal analysis of postoperative shoulder function: a ten-year follow-up study of fullthickness rotator cuff tears. J Bone Joint Surg Am 83-A:1052–1056

    PubMed  CAS  Google Scholar 

  13. Gazielly DF, Gleyze P, Montagnon C (1994) Functional and anatomical results after rotator cuff repair. Clin Orthop 304:43–53

    PubMed  Google Scholar 

  14. Gerber C, Fuchs B, Hodler J (2000) The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 82:505–515

    PubMed  CAS  Google Scholar 

  15. Gerber C, Schneeberger AG, Beck M, Schlegel U (1994) Mechanical strength of repairs of the rotator cuff. J Bone Joint Surg Br 76:371–380

    PubMed  CAS  Google Scholar 

  16. Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg 12:550–554

    Article  PubMed  Google Scholar 

  17. Goutallier D, Postel JM, Lavau L, Bernageau J (1998) Influence of muscular degeneration of the supra- and infra-spinatus on the prognosis of surgical repair of the rotator cuff. Acta Orthop Belg 64(Suppl 2):42–45

    PubMed  Google Scholar 

  18. Harryman DT, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA III (1991) Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 73:982–989

    PubMed  Google Scholar 

  19. Hattrup SJ (1995) Rotator cuff repair: relevance of patient age. J Shoulder Elbow Surg 4:95–100

    Article  PubMed  CAS  Google Scholar 

  20. Hedtmann A, Fett H (1995) Ultrasonography of the shoulder in subacromial syndromes with disorders and injuries of the rotator cuff. Orthopade 24:498–508

    PubMed  CAS  Google Scholar 

  21. Klepps S, Bishop J, Lin J, Cahlon O, Strauss A, Hayes P, Flatow EL (2004) Prospective evaluation of the effect of rotator cuff integrity on the outcome of open rotator cuff repairs. Am J Sports Med 32:1716–1722

    Article  PubMed  Google Scholar 

  22. Knudsen HB, Gelineck J, Sojbjerg JO, Olsen BS, Johannsen HV, Sneppen O (1999) Functional and magnetic resonance imaging evaluation after singletendon rotator cuff reconstruction. J Shoulder Elbow Surg 8:242–246

    Article  PubMed  CAS  Google Scholar 

  23. Lam F, Mok D (2004) Open repair of massive rotator cuff tears in patients aged sixty-five years or over: is it worthwhile? J Shoulder Elbow Surg 13:517–521

    Article  PubMed  CAS  Google Scholar 

  24. Lexell J (1995) Human aging, muscle mass, and fiber type composition. J Gerontol A Biol Sci Med Sci 50 Spec No:11–16

  25. Lo IK, Burkhart SS (2003) Double-row arthroscopic rotator cuff repair: re-establishing the footprint of the rotator cuff. Arthroscopy 19:1035–1042

    Article  PubMed  Google Scholar 

  26. McLaughlin HL (1944) Lesions of the musculotendinous cuff of the shoulder. The exposure and treatment of tears with retraction. J Bone Joint Surg, pp 31–51

  27. Melillo AS, Savoie FH III, Field LD (1997) Massive rotator cuff tears: debridement versus repair. Orthop Clin North Am 28:117–124

    Article  PubMed  CAS  Google Scholar 

  28. Montgomery TJ, Savoie FH, Yerger B (1994) Management of rotator cuff tears: a comparison of arthroscopic debridement and surgical repair. J Shoulder Elbow Surg 3:70–78

    Article  Google Scholar 

  29. Motycka T, Kriegleder B, Landsiedl F (2001) Results of open repair of the rotator cuff—a long-term review of 79 shoulders. Arch Orthop Trauma Surg 121:148–151

    Article  PubMed  CAS  Google Scholar 

  30. Plafki C, Hedtmann A, Fett H, Lutke A, Willburger RE (1997) Results of surgical therapy of ruptures of the rotator cuff of the shoulder. Z Orthop Ihre Grenzgeb 135:360–367

    Article  PubMed  CAS  Google Scholar 

  31. Prasad N, Odumala A, Elias F, Jenkins T (2005) Outcome of open rotator cuff repair. An analysis of risk factors. Acta Orthop Belg 71:662–666

    PubMed  Google Scholar 

  32. Romeo AA, Hang DW, Bach BR Jr, Shott S (1999) Repair of full thickness rotator cuff tears. Gender, age, and other factors affecting outcome. Clin Orthop 367:243–255

    Article  PubMed  Google Scholar 

  33. Ruotolo C, Fow JE, Nottage WM (2004) The supraspinatus footprint: an anatomic study of the supraspinatus insertion. Arthroscopy 20:246–249

    Article  PubMed  Google Scholar 

  34. Sonnabend DH, Watson EM (2002) Structural factors affecting the outcome of rotator cuff repair. J Shoulder Elbow Surg 11:212–218

    Article  PubMed  Google Scholar 

  35. Uhthoff HK, Sarkar K (1991) Surgical repair of rotator cuff ruptures. The importance of the subacromial bursa. J Bone Joint Surg Br 73:399–401

    PubMed  CAS  Google Scholar 

  36. Wolfgang GL (1974) Surgical repair of tears of the rotator cuff of the shoulder. Factors influencing the result. J Bone Joint Surg Am 56:14–26

    PubMed  CAS  Google Scholar 

  37. Yel M, Shankwiler JA, Noonan JE Jr, Burkhead WZ Jr (2001) Results of decompression and rotator cuff repair in patients 65 years old and older: 6- to 14-year follow-up. Am J Orthop 30:347–352

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopädische Universitätsklinik, König-Ludwig-Haus, Brettreichstraße 11, 97074, Würzburg

    T. D. Boehm,  O. Rolf,  B. Baumann,  M. Glatzel,  N. Wollmerstedt &  F. Gohlke

Authors
  1. T. D. Boehm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. Rolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Baumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Glatzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Wollmerstedt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Gohlke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. D. Boehm.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Boehm, T.D., Rolf, O., Baumann, B. et al. Vergleich der funktionellen Ergebnisse nach Rekonstruktion der Rotatorenmanschette bei Patienten vor und ab der 6. Lebensdekade. Obere Extremität 1, 2–7 (2006). https://doi.org/10.1007/s11678-006-0010-5

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11678-006-0010-5

Key words

Schlüsselwörter

Search

Navigation