Rotator Cuff Repair in the Elderly: Is It Worthwhile?

Dimitri S. Tahal, MSc; J. Christoph Katthagen, MD; Peter J. Millett, MD, MSc

Disclosures

Curr Orthop Pract. 2016;27(3):281-290. 

In This Article

Abstract and Introduction

Abstract

Rotator cuff pathology is a major contributor to shoulder dysfunction, particularly in the elderly population. Elderly individuals have shown an increasing desire to remain physically active and have high expectations of treatment. The ideal method to provide pain relief and restore function is controversial, with some surgeons advocating conservative measures and others preferring surgical management. The purpose of this article was to highlight the factors that influence decisionmaking when treating elderly individuals with rotator cuff pathology. Current treatment recommendations with their reported clinical outcomes and possible future developments are discussed.

Introduction

Rotator cuff pathology is a major contributor to shoulder dysfunction, particularly in the elderly population.[1,2] This elderly population (persons 65 yr of age and older) represented approximately 45 million of the U.S. population in the year 2013, which accounted for about one in every seven Americans.[3,4] More than 20% of the elderly population has a full-thickness rotator cuff tear, of which more than a third will clinically manifest.[5,6] This represents approximately 9 million elderly U.S. residents with a full-thickness rotator cuff tear, of which at least 3 million will be symptomatic over time. Due to an aging population and the increasing prevalence of rotator cuff tears with age, the total number of patients with shoulder dysfunction is expected to rise even more in the future.[7,8]

The importance of physical activity in maintaining health and function has been highlighted in the context of ''aging successfully''.[8,9] Moreover, individuals have an increasing desire to remain physically active and have high expectations of returning to high levels of function after treatment. However, the ideal treatment method that provides both pain relief and restores function in elderly individuals is controversial; some surgeons advocate conservative treatment and others support surgical management. In the context of rotator cuff tear in ''the elderly'', it is often stated that patients must be ''appropriately or carefully selected'' for successful treatment outcome.[10,11] However, how is ''appropriately or carefully selected'' defined? The purpose of this article was to highlight key factors to be considered in decision-making when treating elderly individuals with rotator cuff pathology. Furthermore, suggested treatment options with their reported clinical outcomes and possible future developments are discussed.

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