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The characteristics of associated lesions with rotator cuff tears in patients over 70 years old
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Abstracts / Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 9 (2017) 12e58
analyzing. Results: The AESE score was 28.5, 74.2 at 6 months, 86.5 at 1 year. As to CONSTANT score, 25 preoperatively, 71 at 6 months, 88 at 1 year.All data have significant difference compared with preoperatively (P < 0.001) bony union of lesser tuberosity were be evaluated by CT and MRI scan, All the patients get a good recovery with high satisfaction. Conclusion: For bony avulsion of lesser tuberosity combined with Subscapularis injury, the single-row suture repairing method with 2 anchors fixation under arthroscope has the characteristics of curative effect, relatively simple operation, less cost and less trauma. Keywords: bony avulsion, lesser tuberosity, Subscapularis tendon injuries, single-row suture repair
Shoulder - Rotator cuff tear and disorder OP-107 CLINICAL RESULTS OF ROTATOR CUFF REPAIR IN PATIENT OF GLENOHUMERAL OSTEOARTHRITIS Jong Pil Yoon. Department of Orthopaedic Surgery, Kyungpook National University Hospital, South Korea Introduction and Background: Osteoarthritis of the glenohumeral joint is relative combined lesion with rotator cuff tear, especially in elderly patients. The aim of the study was to evaluate the effect of associated osteoarthritis on the treatment outcome of rotator cuff repair. Material and Method: We included 348 patients who had undergone arthroscopic rotator cuff repair for full thickness. Severity of osteoarthritis were evaluated by Samilson-Prieto methods preoperatively, and intraoperatively by Outerbridge classification. 45 patient had concomitant osteoarthritis. Postoperative clinical outcomes were evaluated based on visual analog scale (VAS) for pain, simple shoulder test (SST), University of California, Los Angeles (UCLA), Constant, and American Shoulder and Elbow Surgeons (ASES) scores at baseline, 2 year postoperatively, and final follow-up. Results: Overall, no significant differences in demographic characteristics and baseline data were observed according to existence of osteoarthritis. Clinical symptoms were significantly improved at the final follow-up in both groups. At the final follow-up, no significant differences were found in VAS pain (P ¼ .946), SST (P ¼ .259), UCLA (P ¼ .071), Constant (P ¼ .329), ASES (P ¼ .972) scores. But, in large to massive tears, Patients with osteoarthritis had significantly inferior clinical results than those with no osteoarthritis. Conclusion: Mild to moderate osteoarthritis of the glenohumeral joint is relative combined lesion with rotator cuff tear. Overall, clinical outcome scores showed improvement after rotator cuff repair regardless of osteoarthritis. However, clinicians should consider this potential negative prognostic factor in patients with large to massive tear. Keywords: osteoarthritis, rotator cuff, combined lesion, combined lesion, shoulder
Shoulder - Rotator cuff tear and disorder OP-108 THE CHARACTERISTICS OF ASSOCIATED LESIONS WITH ROTATOR CUFF TEARS IN PATIENTS OVER 70 YEARS OLD Atsushi Okubo 1, Hiroshi Hashiguchi 1, Satoshi Iwashita 2, Kazumasa Abe 1, Minoru Yoneda 2, Shinro Takai 2. 1 Department of Orthopaedic Surgery, Nippon Medical School, Chiba Hokusoh Hospital, Japan; 2 Department of Orthopaedic Surgery, Nippon Medical School, Japan Purpose: The population of elderly people is growing. The incidence of rotator cuff tears (RCTs) increases in elderly, with a tendency to occur as part of the degenerative process of aging. In addition, RCTs with associated lesions have been related to advanced age, and several authors have reported poor result after rotator cuff repair in elderly patients. However, the opinion with clinical outcome in Arthroscopic rotator cuff repair (ARCR) of the elderly patients is still controversial. ARCR has been prevalent and provided for excellent clinical results. The
purpose of this study was to analyze characteristics of RCTs and clinical outcomes of ARCR in patients over 70 years old. Methods: The subjects of 241 patients (251 shoulders) treated by ARCR were divided into two groups. 71 patients (75 shoulders) were elderly group of over 70 years old, which mean age was 73.9 years old, included 37 females and 34 males. 170patients (176 shoulders) were control group of younger than 70 years old, which mean age was 60.1 years old, included 82 females and 88 males. In the elderly group, partial-thickness tears were observed in 10 patients (13.3%), small tear in 23patients (30.7%), medium tear in 32 patients (42.7%), large tear in 4 patients (5.3%), and massive in 6 patients (8.0%). In the control group, partial-thickness tears were observed in 46 patients (26.1%), small tear in 70 patients (39.8%), medium tear in 41 patients (23.3%), large tear in 10 patients (5.7%), and massive in 9 patients (5.1%). The clinical outcomes were evaluated on the basis of the UCLA shoulder score, and the structural outcomes were assessed using postoperative MRI or ultrasound. The average follow-up period was 8.6 months. All data were evaluated statistically by ManneWhitney U test or chi-square test, and the significance level was set at less than 5%. Results: In the elderly group, a subacromial spur were observed in 65.3% patients, glenohumeral joint (GHj) osteoarthritis in 46.7%, acromioclavicular joint (ACj) osteoarthritis in 36.0%, LHB lesion in 24.0%, delamination in 29.3% and labrum lesion in 38.7%. In the control group, a subacromial spur were observed in 43.8% patients, the GHj osteoarthritis in 19.3%, ACj osteoarthritis in 13.6%, LHB lesion in 17.6%, delamination in 19.3% and labrum lesion in 31.8%. Associated lesions were observed in the elderly group more frequently than in the control group. The average UCLA scores improved from 15.3 points preoperatively to 29.4 points postoperatively in the elderly group, and from 16.3 points to 29.9 points in the control group. There was not significantly difference between two groups in postoperative UCLA scores at the final follow-up. Mean postoperative range of flexion of the elderly group was significantly lower than that in the control group. There was not significantly difference about UCLA scores and range of motion between patients with and without associated lesions. Discussion: Clinical outcomes of both the elderly group and the control group significantly improved after ARCR, and there was no significantly difference between two groups. Because elderly patients have various lesions associated with RCTs, it is necessary to perform additional treatments for associated lesions. However, there was significant difference about range of flexion between two groups. This study suggests that associated lesions were not related to postoperative range of flexion. It is considered that muscular strength, compliance with rehabilitation or spondylosis influence the difference of the range of flexion. Conclusion: This study suggests that clinical outcomes of the elderly patients can significantly improve by ARCR. Elderly patients have various lesions associated with RCTs. ARCR with appropriate treatment for associated lesions can provide satisfactory outcomes in elderly patients with RCTs.
Shoulder - Rotator cuff tear and disorder OP-109 A COMPARISON OF CLINICAL OUTCOMES AFTER ARTHROSCOPIC ROTATOR CUFF REPAIR USING SINGLE-ROW, DOUBLE-ROW AND SUTURE BRIDGE TECHNIQUE Huanghe Song, Wang Qing. Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, China Objective: To compare the three techniques for repairing complete rotator cuff tears Methods: A total of 67 shoulders with full-thickness rotator cuff tears received arthroscopic rotator cuff repair from April 2015 to October 2015. Six patients were lost to follow-up. 36 shoulders were repaired using the single-row(SR), 12 shoulders using the double-row(DR), and 13 shoulders using the suture bridge(SB) techniques. Clinical outcomes were evaluated at an average of 8.5 months (range, 6-11 months) after rotator cuff repair. Functional scores, number of suture anchors and surgical time were analyzed. Results: The postoperative ASES(American Shoulder And Elbow Surgeons) scores were 82.04±3.93, 91.76±4.85, and 92.04±3.93 for the SR, DR, and SB
Abstracts / Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 9 (2017) 12e58
analyzing. Results: The AESE score was 28.5, 74.2 at 6 months, 86.5 at 1 year. As to CONSTANT score, 25 preoperatively, 71 at 6 months, 88 at 1 year.All data have significant difference compared with preoperatively (P < 0.001) bony union of lesser tuberosity were be evaluated by CT and MRI scan, All the patients get a good recovery with high satisfaction. Conclusion: For bony avulsion of lesser tuberosity combined with Subscapularis injury, the single-row suture repairing method with 2 anchors fixation under arthroscope has the characteristics of curative effect, relatively simple operation, less cost and less trauma. Keywords: bony avulsion, lesser tuberosity, Subscapularis tendon injuries, single-row suture repair
Shoulder - Rotator cuff tear and disorder OP-107 CLINICAL RESULTS OF ROTATOR CUFF REPAIR IN PATIENT OF GLENOHUMERAL OSTEOARTHRITIS Jong Pil Yoon. Department of Orthopaedic Surgery, Kyungpook National University Hospital, South Korea Introduction and Background: Osteoarthritis of the glenohumeral joint is relative combined lesion with rotator cuff tear, especially in elderly patients. The aim of the study was to evaluate the effect of associated osteoarthritis on the treatment outcome of rotator cuff repair. Material and Method: We included 348 patients who had undergone arthroscopic rotator cuff repair for full thickness. Severity of osteoarthritis were evaluated by Samilson-Prieto methods preoperatively, and intraoperatively by Outerbridge classification. 45 patient had concomitant osteoarthritis. Postoperative clinical outcomes were evaluated based on visual analog scale (VAS) for pain, simple shoulder test (SST), University of California, Los Angeles (UCLA), Constant, and American Shoulder and Elbow Surgeons (ASES) scores at baseline, 2 year postoperatively, and final follow-up. Results: Overall, no significant differences in demographic characteristics and baseline data were observed according to existence of osteoarthritis. Clinical symptoms were significantly improved at the final follow-up in both groups. At the final follow-up, no significant differences were found in VAS pain (P ¼ .946), SST (P ¼ .259), UCLA (P ¼ .071), Constant (P ¼ .329), ASES (P ¼ .972) scores. But, in large to massive tears, Patients with osteoarthritis had significantly inferior clinical results than those with no osteoarthritis. Conclusion: Mild to moderate osteoarthritis of the glenohumeral joint is relative combined lesion with rotator cuff tear. Overall, clinical outcome scores showed improvement after rotator cuff repair regardless of osteoarthritis. However, clinicians should consider this potential negative prognostic factor in patients with large to massive tear. Keywords: osteoarthritis, rotator cuff, combined lesion, combined lesion, shoulder
Shoulder - Rotator cuff tear and disorder OP-108 THE CHARACTERISTICS OF ASSOCIATED LESIONS WITH ROTATOR CUFF TEARS IN PATIENTS OVER 70 YEARS OLD Atsushi Okubo 1, Hiroshi Hashiguchi 1, Satoshi Iwashita 2, Kazumasa Abe 1, Minoru Yoneda 2, Shinro Takai 2. 1 Department of Orthopaedic Surgery, Nippon Medical School, Chiba Hokusoh Hospital, Japan; 2 Department of Orthopaedic Surgery, Nippon Medical School, Japan Purpose: The population of elderly people is growing. The incidence of rotator cuff tears (RCTs) increases in elderly, with a tendency to occur as part of the degenerative process of aging. In addition, RCTs with associated lesions have been related to advanced age, and several authors have reported poor result after rotator cuff repair in elderly patients. However, the opinion with clinical outcome in Arthroscopic rotator cuff repair (ARCR) of the elderly patients is still controversial. ARCR has been prevalent and provided for excellent clinical results. The
purpose of this study was to analyze characteristics of RCTs and clinical outcomes of ARCR in patients over 70 years old. Methods: The subjects of 241 patients (251 shoulders) treated by ARCR were divided into two groups. 71 patients (75 shoulders) were elderly group of over 70 years old, which mean age was 73.9 years old, included 37 females and 34 males. 170patients (176 shoulders) were control group of younger than 70 years old, which mean age was 60.1 years old, included 82 females and 88 males. In the elderly group, partial-thickness tears were observed in 10 patients (13.3%), small tear in 23patients (30.7%), medium tear in 32 patients (42.7%), large tear in 4 patients (5.3%), and massive in 6 patients (8.0%). In the control group, partial-thickness tears were observed in 46 patients (26.1%), small tear in 70 patients (39.8%), medium tear in 41 patients (23.3%), large tear in 10 patients (5.7%), and massive in 9 patients (5.1%). The clinical outcomes were evaluated on the basis of the UCLA shoulder score, and the structural outcomes were assessed using postoperative MRI or ultrasound. The average follow-up period was 8.6 months. All data were evaluated statistically by ManneWhitney U test or chi-square test, and the significance level was set at less than 5%. Results: In the elderly group, a subacromial spur were observed in 65.3% patients, glenohumeral joint (GHj) osteoarthritis in 46.7%, acromioclavicular joint (ACj) osteoarthritis in 36.0%, LHB lesion in 24.0%, delamination in 29.3% and labrum lesion in 38.7%. In the control group, a subacromial spur were observed in 43.8% patients, the GHj osteoarthritis in 19.3%, ACj osteoarthritis in 13.6%, LHB lesion in 17.6%, delamination in 19.3% and labrum lesion in 31.8%. Associated lesions were observed in the elderly group more frequently than in the control group. The average UCLA scores improved from 15.3 points preoperatively to 29.4 points postoperatively in the elderly group, and from 16.3 points to 29.9 points in the control group. There was not significantly difference between two groups in postoperative UCLA scores at the final follow-up. Mean postoperative range of flexion of the elderly group was significantly lower than that in the control group. There was not significantly difference about UCLA scores and range of motion between patients with and without associated lesions. Discussion: Clinical outcomes of both the elderly group and the control group significantly improved after ARCR, and there was no significantly difference between two groups. Because elderly patients have various lesions associated with RCTs, it is necessary to perform additional treatments for associated lesions. However, there was significant difference about range of flexion between two groups. This study suggests that associated lesions were not related to postoperative range of flexion. It is considered that muscular strength, compliance with rehabilitation or spondylosis influence the difference of the range of flexion. Conclusion: This study suggests that clinical outcomes of the elderly patients can significantly improve by ARCR. Elderly patients have various lesions associated with RCTs. ARCR with appropriate treatment for associated lesions can provide satisfactory outcomes in elderly patients with RCTs.
Shoulder - Rotator cuff tear and disorder OP-109 A COMPARISON OF CLINICAL OUTCOMES AFTER ARTHROSCOPIC ROTATOR CUFF REPAIR USING SINGLE-ROW, DOUBLE-ROW AND SUTURE BRIDGE TECHNIQUE Huanghe Song, Wang Qing. Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, China Objective: To compare the three techniques for repairing complete rotator cuff tears Methods: A total of 67 shoulders with full-thickness rotator cuff tears received arthroscopic rotator cuff repair from April 2015 to October 2015. Six patients were lost to follow-up. 36 shoulders were repaired using the single-row(SR), 12 shoulders using the double-row(DR), and 13 shoulders using the suture bridge(SB) techniques. Clinical outcomes were evaluated at an average of 8.5 months (range, 6-11 months) after rotator cuff repair. Functional scores, number of suture anchors and surgical time were analyzed. Results: The postoperative ASES(American Shoulder And Elbow Surgeons) scores were 82.04±3.93, 91.76±4.85, and 92.04±3.93 for the SR, DR, and SB