Amy E. Abbot, MD, et al
In The American Journal of Sports Medicine. July 2009. Vol. 37. No. 7. Pp. 1358-1362
At age 50, just slightly more than one in 10 adults has a rotator cuff tear seen on MRIs. By age 80, this has increased to five out of 10 (or half of all adults).
The authors of this study are surgeons from a sports medicine clinic. They compared the results of surgery for rotator cuff tears and superior labral anterior posterior (SLAP) lesions when treated with rotator cuff repair and debridement of the SLAP lesion (group one) versus rotator cuff and SLAP repair (group two).
All patients were 45 years old or older. They all had arthroscopic surgery and they all had a tear of the supraspinatus tendon. Two other characteristics of the patients in this study included 1) the SLAP lesion was considered repairable and 2) the torn tendons weren’t retracted very far. The surgeon was able to grab the tendon and stitch it back in place.
To measure the results of treatment, range of motion was recorded before and after surgery. And each participant filled out the Tegner and UCLA self-reported tests of activity level and function, patient satisfaction, range-of-motion, and strength. Before surgery, the groups were evenly matched with similar results on all test scores.
After surgery, the debridement group had better results than the repair group. Everyone in both groups did improve, but patients in the debridement group got better faster. The got faster and better pain relief, which translated in to improved function as well. And two years later, they were still showing improved shoulder rotation compared with the repair group.
The authors concluded that in older adults minimal intervention might be best. With combined shoulder lesions (rotator cuff and labral tears), functional outcome is better when the SLAP lesion is shaved smooth rather than anchored back in place. The reason for this might be because (as has been shown in other studies), the labrum in older adults loses blood supply and has fewer new chondrocytes (cartilage cells) to replace the damaged ones.