Treatment of rotator cuff tears in older individuals: a systematic review

Background: Rotator cuff disease is common in older adults and may compromise health status and functional independence. However, little evidence exists to guide the treatment of rotator cuff tears (RCTs) in the older patient. This study evaluated the evidence regarding treatment of RCTs in patients with a mean age of 60 years or older. Methods: PubMed, SCOPUS, Science Citation Index (Web of Knowledge), Sport Discus, CINAHL, The Cochrane Controlled Trials registry, podium and poster presentations, proceedings, and abstracts from American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and American Shoulder and Elbow Surgeons were searched for published and unpublished studies from 1966 to 2009. Inclusion criteria were English language, level of evidence I to III or greater, a full-thickness RCT, and treatment (surgery, physical therapy, injections, medications, or observation). Exclusion criteria included purely retrospective studies, isolated tears of the subscapularis, partial RCTs, revision surgery, and grafting or tendon transfer procedures. The blinded studies were independently evaluated using principles in the CONSORT (Consolidated Standards of Reporting Trials, 2001) statement and then collated by level of evidence and treatment strategy. Results: Eight studies (1 level I, 4 level II, and 3 level III) evaluated treatment outcomes in patients aged older than 60 years. Review of the included operative studies suggests possible efficacy with operative intervention. However, heterogeneity of these studies and bias did not allow for a valid consensus on the best treatment approach. Conclusions: There is insufficient evidence to suggest efficacy in operative or nonoperative treatment of RCTs in older patients. The results presented here suggest possible favorable outcomes with operative management of RCTs. Level of evidence: Level III, Systematic Review. (C) 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.