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Arthroscopic Management of Massive Irreparable Rotator Cuff Tears: Whole Rotator Cable Reconstruction Using Proximal Biceps Tendon Autograft
Published on: June 6, 2025
Rotator cuff tears in young patients: a different disease than rotator cuff tears in elderly patients
Alexander L Lazarides1, Eduard Alentorn-Geli2, J H James Choi2
1School of Medicine, Duke University, Durham, NC, USA.
Insights
Rotator cuff tears in young patients often stem from trauma, responding well to surgical repair. Elite throwers, however, face challenges returning to play despite improved outcomes.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Rehabilitative Medicine
Background:
- Rotator cuff tears are prevalent in young athletes and active individuals.
- Understanding injury mechanisms and treatment outcomes is crucial for this demographic.
Purpose of the Study:
- To systematically review literature on rotator cuff tears in patients under 40.
- To evaluate injury characteristics and treatment outcomes.
Main Methods:
- Systematic electronic search of clinical studies.
- Inclusion criteria: patients <40 years, rotator cuff tears, minimum 1-year follow-up.
- Emphasis on injury characteristics and treatment outcomes.
Main Results:
- Twelve studies (336 patients, mean age 28) were included.
- Two subgroups identified: traumatic full-thickness tears (majority) and chronic overuse partial-thickness tears (elite throwers).
- Surgical repair improved pain and strength; 87% patient satisfaction. Elite throwers had suboptimal return to play (25%-97%).
Conclusions:
- Young patients with traumatic rotator cuff tears achieve good outcomes with surgical repair.
- Elite throwers represent a distinct subgroup with improved, yet suboptimal, return-to-play rates after treatment.
- Differentiated treatment and rehabilitation strategies may be needed for these distinct patient groups.
Background:
The purpose of this study was to conduct a systematic review of the literature to evaluate the characteristics of injury and treatment outcomes of rotator cuff tears in young patients.
Methods:
A systematic electronic search was performed for clinical studies evaluating rotator cuff tears in patients younger than 40 years with special emphasis on reporting of injury characteristics and treatment outcomes with a minimum 1-year follow-up.
Results:
Twelve studies (involving 336 patients) met inclusion criteria. The mean age of the patients was 28 years (range, 16-40 years), with a mean follow-up of 39 months. There were 2 distinct subgroups. The majority of studies (7 of 10) showed that patients typically had a full-thickness tear with an acute traumatic etiology. However, within the subgroup of elite throwers, 5 of 6 studies demonstrated a majority of tears that were partial thickness stemming from chronic overuse. Rotator cuff repair improved pain and strength in almost all studies reporting on these parameters. Eighty-seven percent of patients reported they were satisfied. However, all studies examining elite throwers showed significant difficulty in returning to play (25%-97%).
Conclusions:
In young patients with rotator cuff tears, there are 2 primary groups. (1) A majority group with rotator cuff tears of traumatic origin responded well to both arthroscopic and open rotator cuff repair in terms of pain relief and self-reported outcomes postoperatively. These patients reported high levels of satisfaction and return to preinjury level of play. (2) A unique subpopulation composed of elite throwers had improved outcomes but suboptimal return to play.
