Arthroscopic rotator cuff repair is a safe and effective option for adults, including those older than 70 years, based on data from two studies published in the journal Arthroscopy.
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Researchers found that arthroscopic rotator cuff repair was safe and effective for seniors older than 70. Rehabilitation often includes passive range of motion exercises that eventually progress to strengthening exercises.
In one prospective, randomized, double-blind study, a single 300-mg dose of gabapentin before arthroscopic rotator cuff surgery significantly reduced pain during the first 24 hours after surgery, compared with a placebo, with no increase in side effects.
Previous studies have shown that 300- to 1,200-mg doses of gabapentin can reduce postoperative pain, but side effects at higher doses remain a concern because of the older age of many patients who undergo rotator cuff surgery, the researchers noted.
To determine the effect of low-dose gabapentin on postoperative pain, Dr. Si Ra Bang of Sungkyunkwan University in Suwon, South Korea, and colleagues randomized 46 adults to receive either 300-mg gabapentin or a placebo 2 hours before surgery.
The average visual analog scale scores at 2, 6, and 12 hours after surgery were significantly lower in the gabapentin group, compared with the placebo group. The most common side effects were nausea and vomiting. Neither the use of fentanyl nor the occurrence of side effects was significantly different between the two groups. There were no significant demographic differences between the groups, and the average age of the patients was 58 years. (Arthroscopy 2010;26[suppl.]:S106-111).
The results suggest that “preoperative gabapentin may be useful in outpatient-based arthroscopic repair,” the researchers said. But more studies are needed to confirm the findings and the correct dose of gabapentin, they added.
In another study, Dr. Nikhil N. Verma of Rush University in Chicago and colleagues focused on outcomes of arthroscopic rotator cuff repair in 44 consecutive adults aged 70 years and older. After an average of 3 years’ follow-up, complete data were available for 39 patients with an average age of 75 years (Arthroscopy October 2010 [doi:10.1016/j.arthro.2010.01.031]).
Scores on the ASES (American Shoulder and Elbow Surgeons) scale, the SST (Simple Shoulder Test), and a visual analog pain scale improved significantly from baseline to final follow-up.
“Because elderly individuals increasingly desire to remain physically active, their activity expectations often justify surgical treatment of a rotator cuff lesion,” the case series investigators said.
At the final follow-up, the mean active forward flexion on the affected shoulder was 31.4 degrees greater, representing a significant improvement both from baseline (114.8 degrees) and postoperatively (146.2 degrees). The mean ASES score improved from 45.8 to 87.5, and the mean SST score improved from 3.9 to 9.8. The mean VAS pain score dropped from 4.6 to 0.5.
The study group included 18 men and 21 women. None of the patients reported a history of tobacco use, four had diabetes, and two had rheumatoid arthritis. The mean size of the rotator cuff tear was 3.24 cm. The tears were repaired with bioabsorbable or metal suture anchors.
The rehab process for all patients included passive range of motion and keeping the affected arm in a sling for 6 weeks, followed by 6 weeks of active motion, progressing to strengthening exercises after 12 weeks.
A majority of the patients (94%) said that they were satisfied with the results of the surgery and would do it again.
The study was limited by the lack of a control group and the lack of postoperative-imaging data, but it is the largest study of arthroscopic rotator cuff surgery in adults aged 70 years and older. Data on postoperative complications were similar to those from previous studies.
Given that the goal of rotator cuff surgery is improvement in pain and function, the results justify the use of arthroscopic rotator cuff surgery to treat older adults, the researchers said.
Dr. Verma and several colleagues have received research or institutional support from or served as consultants to orthopedic industry companies such as Arthrex, DJ Orthopaedics, Ossur, Smith & Nephew, Miomed, Athletico, and Linvatec. Dr. Bang and colleagues reported no financial conflicts.