Long-term results of the rotator cuff tears treatment after anterior shoulder dislocation in middle-aged and senior patients

Introduction: More than 20% of shoulder dislocations occur in individuals over 40 years of age. Current treatment algorithms for shoulder dislocation management include conservative treatment with immobilization and subsequent rehabilitation, which leads to an unsatisfactory result (decreased function, pain) in more than 50% of older patients. It is associated with damage to the rotator cuff tendons (RCT) and subsequent muscle degeneration.

The aim of the study was to improve the results of the diagnosis and treatment for patients over 45 years of age with primary traumatic dislocation of the shoulder with varying degrees of RCT damage.

Materials and methods: 85 patients (60.2±11.4 years, 44 men, 41 women). Inclusion criteria: first-time dislocation, consent to participate in the study. Radiographs and magnetic resonance imaging (MRI) of the shoulder joint were performed with assessment of the subacromial space and acromiohumeral index (AHI). Next groups were formed: Comparison group 1 (rehabilitation treatment of full-thickness RCT damage, 18 people), comparison group 2 (rehabilitation treatment of partial-thickness RCT damage, 21 people), study group (surgical treatment of full-thickness RCT damage, 24 people). Also, to reduce damage to the RCT muscles, 2 comparable groups were randomly formed: group taking a mixed amino acids (leucine:isoleucine:valine) and group taking placebo.

Results: a significant correlation between the AHI and the width of the subacromial space (Pearson's rxy = 0.895, p <0.001) was obtained, the approximation value was 0.7902. ROC analysis revealed the optimal threshold value of the API - the probability of absence of narrowing of the subacromial space <6 mm on MRI increases with API ≥ 1.26 (sensitivity and specificity 94.8% and 86.5%). Comparing the treatment results according to the ASES, DASH, UCLA questionnaire scales, the treatment results in the treatment and comparison groups 2 are significantly better than in the comparison group 1, and there are no differences between the study and comparison groups 2. Amino acid supplementation did not reduce basal rates of muscle membrane damage compared with placebo.

Conclusion: AHI assessment is applicable for RCT injuries diagnosis; MRI is recommended for patients over 45 years of age with a shoulder dislocation. For full-thickness tendon injuries, surgical refixation is optimal; In case of partial-thickness damage, conservative rehabilitation is recommended. Comparison of treatment methods for partial-thickness tendon injuries requires further analysis.

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