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Shoulder Surgery For Patients Over Age 50

When adults over the age of 50 injure their rotator cuff, how much of the soft tissue damage should be repaired? That's the focus of this study, which may be the first to report results on rotator cuff tears (RCTs) with a superior labrum anterior and posterior (SLAP) lesion in patients older than 50.

A RCT refers to one of the four tendons that surround and help hold the shoulder joint in place. SLAP lesions affect the labrum, a thin ridge of cartilage around the shoulder joint. There are several types of SLAP injuries. In this study, only patients with a type II injury are included. Type II is a cartilage tear with an unstable biceps tendon anchor (place where it inserts).

The results of surgical procedures for RCTs with a SLAP lesion were compared. All patients were over age 50 and had both a RCT and a type II SLAP lesion. These injuries were diagnosed and confirmed with an arthroscopic exam. Size, shape, and type of tears were noted. The author described the arthroscopic technique used.

One group had both injuries surgically repaired. The second group had a RCT without repair of the SLAP lesion. Instead, the biceps tendon was removed from the labrum before the labrum was repaired. This procedure is called a biceps tenotomy.

Before and after assessments were performed for both groups using the UCLA shoulder rating scale. Pain, range of motion, and patient satisfaction were the main measures. Strength and function were also reported. Patients who had the tenotomy instead of a full repair had better overall results.

Follow-up was long enough (five years) to show outcomes after recovery was complete. Long-term follow-up was necessary because postoperative stiffness is common with these injuries. The study had to be long enough to track potential cases of postop stiffness.

As a result, the authors no longer see the need to repair a type II SLAP lesion in adults with a RCT after age 50. They found that it is possible to repair the RCT and leave the SLAP tear alone. Performing a biceps tenotomy along with the RCT repair may be all that's needed for this age group.

References: Francesco Franceschi, MD, et al. No Advantages in Repairing a Type II Superior Labrum Anterior and Posterior (SLAP) Lesion When Associated With Rotator Cuff Repair in Patients Over Age 50. In The American Journal of Sports Medicine. February 2008.Vol. 36. No. 2. Pp. 247-253.

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