Effect of Age on Functional and Structural Outcome After Rotator Cuff Repair

Authors: Joo Han Oh, Sae Hoon Kim, Jong Yeal Kang, Chung Hee Oh, and Hyun Sik Gong

References: Am J Sports Med 2010;38 672-678

Background
There are numerous reports on the outcome of rotator cuff repair according to age. However, the results are conflicting and driven by univariate analysis, which is not free of confounding factors.

Hypothesis
Age does not affect the anatomical and functional outcomes of rotator cuff repair.

Study design
Case series; Level of evidence, 4.

Materials and Methods
Eighty-one men and 96 women underwent rotator cuff repair at one institution and received computed tomography arthrography and functional evaluations at least 1 year after surgery. Various structural and clinical features according to age were evaluated. The correlation was assessed between age and outcomes, with adjustment for the preoperative score.

Results
Patient mean age was 60.0 8.7 years. The mean ages were higher in women, nonsmokers, and those with positive paradoxical abduction, lower level of sports activity, the presence of biceps injury, higher fatty degeneration in cuff muscles, inferior isokinetic muscle performance, bigger tear size, more retraction of tear, and symptomatic acromioclavicular arthritis. For the integrity of the repair, the mean age was higher in the retear group (31.1%) than in the intact group (68.9%)that is, 63.7 7.5 and 58.4 8.7 years, respectively (P <.001). Only the Constant score exhibited a positive correlation with age after adjustment (P = .009). Univariate regression analysis revealed that a 0.313-point increment of Constant score could be expected for each year of age.

Conclusion
On univariate analysis, older age was related with poor postoperative integrity and better functional improvement in Constant score. Multivariate regression revealed that age was not an independent determinant for anatomical or functional outcome whereas the tear retraction and fatty degeneration of the infraspinatus were independent factors for the integrity of repair and the presence of the paradoxical abduction and abduction torque of the unaffected shoulder for the Constant score.