Arthroscopic Repair Benefits Reparable Rotator Cuff Tear Patients Aged 65 Years or Older With a History of Traumatic Events

Published:December 27, 2022DOI:


      To evaluate the clinical outcomes of arthroscopic rotator cuff repair at 2-year follow-up in patients aged 65 years or older with a history of traumatic events divided into groups based on symptom duration (<3 months, 3-6 months, and >6 months from injury to surgery) and to compared patient-reported outcomes among the 3 groups.


      Between 2015 and 2020, 110 patients who met the inclusion criteria were enrolled in this study; these patients were divided into 3 groups according to symptom duration: less than 3 months (group A), 3 to 6 months (group B) and more than 6 months (group C). Preoperative and 2-year postoperative clinical outcomes were compared, including American Shoulder and Elbow Surgeons, Constant-Murley, University of California, Los Angeles, Simple Shoulder Test, and visual analog scale scores; forward elevation; external rotation; and internal rotation. The minimal clinically important difference (MCID), patient acceptable symptom state, substantial clinical benefit, and maximum outcome improvement were also compared among the groups.


      The American Shoulder and Elbow Surgeons score, as the primary outcome, improved significantly from 41.0 ± 18.5 to 85.4 ± 8.1 in group A, from 53.7 ± 14.3 to 86.3 ± 11.7 in group B, and from 49.7 ± 18.5 to 83.9 ± 11.9 in group C. All the other parameters showed statistically significant improvements at 2-year follow-up in each group (all P < .05). There was no significant difference in each parameter among the 3 groups except the visual analog scale score, which did not achieve the MCID. Overall, 86 patients (78.2%) exceeded the MCID, 87 patients (79.1%) achieved the patient acceptable symptom state, 77 patients (70.0%) achieved substantial clinical benefit, and 62 patients (56.4%) achieved maximum outcome improvement without significant differences among the 3 groups.


      In rotator cuff tear patients aged 65 years or older with a history of traumatic events, arthroscopic rotator cuff repair significantly improves clinical outcomes at 2-year follow-up regardless of symptom duration if the tear is fully reparable.

      Level of Evidence

      Level III, prognostic retrospective study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kholinne E.
        • Kwak J.M.
        • Cho C.H.
        • et al.
        Arthroscopic superior capsular reconstruction for older patients with irreparable rotator cuff tears: A comparative study with younger patients.
        Am J Sports Med. 2021; 49: 2751-2759
        • Fossati C.
        • Stoppani C.
        • Menon A.
        • Pierannunzii L.
        • Compagnoni R.
        • Randelli P.S.
        Arthroscopic rotator cuff repair in patients over 70 years of age: A systematic review.
        J Orthop Traumatol. 2021; 22: 3
        • Fehringer E.V.
        • Sun J.
        • VanOeveren L.S.
        • Keller B.K.
        • Matsen III, F.A.
        Full-thickness rotator cuff tear prevalence and correlation with function and co-morbidities in patients sixty-five years and older.
        J Shoulder Elbow Surg. 2008; 17: 881-885
        • Dang A.
        • Davies M.
        Rotator cuff disease: Treatment options and considerations.
        Sports Med Arthrosc Rev. 2018; 26: 129-133
        • Tashjian R.Z.
        Epidemiology, natural history, and indications for treatment of rotator cuff tears.
        Clin Sports Med. 2012; 31: 589-604
        • Burkhart S.S.
        • Barth J.R.
        • Richards D.P.
        • Zlatkin M.B.
        • Larsen M.
        Arthroscopic repair of massive rotator cuff tears with stage 3 and 4 fatty degeneration.
        Arthroscopy. 2007; 23: 347-354
        • Bassett R.W.
        • Cofield R.H.
        Acute tears of the rotator cuff. The timing of surgical repair.
        Clin Orthop. 1983; 175: 18-24
        • Hantes M.E.
        • Karidakis G.K.
        • Vlychou M.
        • Varitimidis S.
        • Dailiana Z.
        • Malizos K.N.
        A comparison of early versus delayed repair of traumatic rotator cuff tears.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1766-1767
        • Petersen S.A.
        • Murphy T.P.
        The timing of rotator cuff repair for the restoration of function.
        J Shoulder Elbow Surg. 2011; 20: 62-68
        • Duncan N.S.
        • Booker S.J.
        • Gooding B.W.
        • Geoghegan J.
        • Wallace W.A.
        • Manning P.A.
        Surgery within 6 months of an acute rotator cuff tear significantly improves outcome.
        J Shoulder Elbow Surg. 2015; 24: 1876-1880
        • Zhaeentan S.
        • Von Heijne A.
        • Stark A.
        • Hagert E.
        • Salomonsson B.
        Similar results comparing early and late surgery in open repair of traumatic rotator cuff tears.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 3899-3906
        • Aagaard K.E.
        • Björnsson Hallgren H.C.
        • Lunsjö K.
        • Frobell R.
        No differences in histopathological degenerative changes found in acute, trauma-related rotator cuff tears compared with chronic, nontraumatic tears.
        Knee Surg Sports Traumatol Arthrosc. 2022; 30: 2521-2527
        • Molloy T.J.
        • Kemp M.W.
        • Wang Y.
        • Murrell G.A.
        Microarray analysis of the tendinopathic rat supraspinatus tendon: Glutamate signaling and its potential role in tendon degeneration.
        J Appl Physiol. 2006; 101: 1702-1709
        • Boileau P.
        • Brassart N.
        • Watkinson D.J.
        • Carles M.
        • Hatzidakis A.M.
        • Krishnan S.G.
        Arthroscopic repair of full-thickness tears of the supraspinatus: Does the tendon really heal?.
        J Bone Joint Surg Am. 2005; 87: 1229-1240
        • Verma N.N.
        • Bhatia S.
        • Baker III, C.L.
        • et al.
        Outcomes of arthroscopic rotator cuff repair in patients aged 70 years or older.
        Arthroscopy. 2010; 26: 1273-1280
        • Rashid M.S.
        • Cooper C.
        • Cook J.
        • et al.
        Increasing age and tear size reduce rotator cuff repair healing rate at 1 year.
        Acta Orthop. 2017; 88: 606-611
        • Nicholson J.A.
        • Searle H.K.C.
        • MacDonald D.
        • McBirnie J.
        Cost-effectiveness and satisfaction following arthroscopic rotator cuff repair: Does age matter?.
        Bone Joint J. 2019; 101-B: 860-866
        • Robinson P.M.
        • Wilson J.
        • Dalal S.
        • Parker R.A.
        • Norburn P.
        • Roy B.R.
        Rotator cuff repair in patients over 70 years of age: Early outcomes and risk factors associated with retear.
        Bone Joint J. 2013; 95: 199-205
        • Charousset C.
        • Bellaïche L.
        • Kalra K.
        • Petrover D.
        Arthroscopic repair of full-thickness rotator cuff tears: Is there tendon healing in patients aged 65 years or older?.
        Arthroscopy. 2010; 26: 302-309
        • Flurin P.H.
        • Hardy P.
        • Abadie P.
        • et al.
        Arthroscopic repair of the rotator cuff: Prospective study of tendon healing after 70 years of age in 145 patients.
        Orthop Traumatol Surg Res. 2013; 99: 379-384
        • Rhee Y.G.
        • Cho N.S.
        • Yoo J.H.
        Clinical outcome and repair integrity after rotator cuff repair in patients older than 70 years versus patients younger than 70 years.
        Arthroscopy. 2014; 30: 546-554
        • Moraiti C.
        • Valle P.
        • Maqdes A.
        • et al.
        Comparison of functional gains after arthroscopic rotator cuff repair in patients over 70 years of age versus patients under 50 years of age: A prospective multicenter study.
        Arthroscopy. 2015; 31: 184-190
        • Altintas B.
        • Anderson N.L.
        • Pitta R.
        • et al.
        Repair of rotator cuff tears in the elderly: Does it make sense? A systematic review.
        Am J Sports Med. 2020; 48: 744-753
        • Vandenbroucke J.P.
        • von Elm E.
        • Altman D.G.
        • et al.
        Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration.
        Int J Surg. 2014; 12: 1500-1524
        • DeOrio J.K.
        • Cofield R.H.
        Results of a second attempt at surgical repair of a failed initial rotator-cuff repair.
        J Bone Joint Surg Am. 1984; 66: 563-567
        • Michener L.A.
        • McClure P.W.
        • Sennett B.J.
        American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: Reliability, validity, and responsiveness.
        J Shoulder Elbow Surg. 2002; 11: 587-594
        • Richards R.R.
        • An K.N.
        • Bigliani L.U.
        • et al.
        A standardized method for the assessment of shoulder function.
        J Shoulder Elbow Surg. 1994; 3: 347-352
        • Tashjian R.Z.
        • Hung M.
        • Keener J.D.
        • et al.
        Determining the minimal clinically important difference for the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and visual analog scale (VAS) measuring pain after shoulder arthroplasty.
        J Shoulder Elbow Surg. 2017; 26: 144-148
        • Constant C.R.
        • Gerber C.
        • Emery R.J.
        • Sojbjerg J.O.
        • Gohlke F.
        • Boileau P.
        A review of the Constant score: Modifications and guidelines for its use.
        J Shoulder Elbow Surg. 2008; 17: 355-361
        • Constant C.R.
        • Murley A.H.
        A clinical method of functional assessment of the shoulder.
        Clin Orthop Relat Res. 1987; 214: 160-164
        • Amstutz H.C.
        • Sew Hoy A.L.
        • Clarke I.C.
        UCLA anatomic total shoulder arthroplasty.
        Clin Orthop Relat Res. 1981; 155: 7-20
        • Ellman H.
        • Hanker G.
        • Bayer M.
        Repair of the rotator cuff: End-result study of factors influencing reconstruction.
        J Bone Joint Surg Am. 1986; 68: 1136-1144
        • Lippitt S.B.
        • Harryman D.T.
        • Matsen F.A.
        A practical tool for evaluating function: The simple shoulder test.
        American Academy of Orthopaedic Surgeons, Rosemont, IL1993
        • Gowd A.K.
        • Cvetanovich G.L.
        • Liu J.N.
        • et al.
        Preoperative mental health scores and achieving patient acceptable symptom state are predictive of return to work.
        Orthop J Sports Med. 2019; 72325967119878415
        • Kim D.M.
        • Kim T.H.
        • Kholinne E.
        • et al.
        Minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state after arthroscopic rotator cuff repair.
        Am J Sports Med. 2020; 11: 2650-2659
      1. Beck EC, Gowd AK, Liu JN, et al. How is maximum outcome improvement defined in patients undergoing shoulder arthroscopy for rotator cuff repair? A 1-year follow-up study. Arthroscopy 36;7:1805-1810.

        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Faucett S.C.
        • Dhawan A.
        Research pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.
        Arthroscopy. 2017; 33: 1102-1112
        • Gagnier J.J.
        • Robbins C.
        • Bedi A.
        • Carpenter J.E.
        • Miller B.S.
        Establishing minimally important differences for the American Shoulder and Elbow Surgeons score and the Western Ontario Rotator Cuff Index in patients with full-thickness rotator cuff tears.
        J Shoulder Elbow Surg. 2018; 27: 160-166
        • Tashjian R.Z.
        • Deloach J.
        • Porucznik C.A.
        • Powell A.P.
        Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease.
        J Shoulder Elbow Surg. 2009; 18: 927-932
        • Triplet J.J.
        • Everding N.G.
        • Levy J.C.
        • et al.
        Anatomic and reverse total shoulder arthroplasty in patients older than 80 years.
        Orthopedics. 2015; 38: 904-910
        • Lafosse L.
        • Brozska R.
        • Toussaint B.
        • Gobezie R.
        The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique.
        J Bone Joint Surg Am. 2007; 89: 1533-1541
        • Galatz L.M.
        • Ball C.M.
        • Teefey S.A.
        • Middleton W.D.
        • Yamaguchi K.
        The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears.
        J Bone Joint Surg Am. 2004; 86: 219-224
        • Djahangiri A.
        • Cozzolino A.
        • Zanetti M.
        • et al.
        Outcome of single-tendon rotator cuff repair in patients aged older than 65 years.
        J Shoulder Elbow Surg. 2013; 22: 45-51
        • Klepps S.
        • Bishop J.
        • Lin J.
        • et al.
        Prospective evaluation of the effect of rotator cuff integrity on the outcome of open rotator cuff repairs.
        Am J Sports Med. 2004; 32: 1716-1722
        • Plachel F.
        • Siegert P.
        • Rüttershoff K.
        • et al.
        Arthroscopic revision cuff repair: Do tendons have a second chance to heal?.
        J Shoulder Elbow Surg. 2020; 29: 1815-1820
        • Sambandam S.N.
        • Khanna V.
        • Gul A.
        • Mounasamy V.
        Rotator cuff tears: An evidence based approach.
        World J Orthop. 2015; 6: 902-918
        • Goldberg B.A.
        • Nowinski R.J.
        • Matsen III, F.A.
        Outcome of nonoperative management of full-thickness rotator cuff tears.
        Clin Orthop Relat Res. 2001; 382: 99-107
        • Huegel J.
        • Williams A.A.
        • Soslowsky L.J.
        Rotator cuff biology and biomechanics: A review of normal and pathological conditions.
        Curr Rheumatol Rep. 2015; 17: 476
        • Zingg P.O.
        • Jost B.
        • Sukthankar A.
        • Buhler M.
        • Pfirrmann C.W.
        • Gerber C.
        Clinical and structural outcomes of nonoperative management of massive rotator cuff tears.
        J Bone Joint Surg Am. 2007; 89: 1928-1934
        • Kim Y.K.
        • Jung K.H.
        • Kim J.W.
        • Kim U.S.
        • Hwang D.H.
        Factors affecting rotator cuff integrity after arthroscopic repair for medium-sized or larger cuff tears: A retrospective cohort study.
        J Shoulder Elbow Surg. 2018; 27: 1012-1020
        • Cho C.H.
        • Jung S.W.
        • Park J.Y.
        • Song K.S.
        • Yu K.I.
        Is shoulder pain for three months or longer correlated with depression, anxiety, and sleep disturbance?.
        J Shoulder Elbow Surg. 2013; 22: 222-228
        • Lépine J.P.
        • Briley M.
        The increasing burden of depression.
        Neuropsychiatr Dis Treat. 2011; 7: 3-7
        • Yeon Jeong H.Y.
        • Kim H.J.
        • Jeon Y.S.
        • Rhee Y.G.
        Factors predictive of healing in large rotator cuff tears: Is it possible to predict retear preoperatively?.
        Am J Sports Med. 2018; 46: 1693-1700
        • Keener J.D.
        • Patterson B.M.
        • Orvets N.
        • Chamberlain A.M.
        Degenerative rotator cuff tears: Refining surgical indications based on natural history data.
        J Am Acad Orthop Surg. 2019; 27: 156-165
        • Lee S.H.
        • Nam D.J.
        • Kim S.J.
        • Kim J.W.
        Comparison of clinical and structural outcomes by subscapularis tendon status in massive rotator cuff tear.
        Am J Sports Med. 2017; 45: 2555-2562
        • Lu Y.
        • Lu Y.J.
        • Zhu Y.M.
        • Shen J.W.
        • Li F.L.
        • Jiang C.Y.
        Clinical results on repair of massive rotator cuff tears.
        Chin J Trauma. 2011; 27: 441-445