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Updated: Aug 9, 2025
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Long-term functional and structural outcome of rotator cuff repair in patients 60 years old or less
Andrew Green1, Kelsey Loyd2, Janine Molino3
1Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
Insights
Rotator cuff repair (RCR) in younger patients shows significant long-term functional improvement despite structural changes. Factors like male sex and traumatic tears predict better outcomes, while comorbidities and larger tears correlate with worse results.
Area of Science:
- Orthopedic Surgery
- Musculoskeletal Research
- Regenerative Medicine
Background:
- Long-term outcomes of rotator cuff repair (RCR) are not well-documented.
- Evaluating RCR's long-term functional and structural effects in younger individuals is crucial.
Purpose of the Study:
- To assess long-term functional and structural results following RCR in a cohort of younger patients.
- To identify factors influencing these long-term outcomes.
Main Methods:
- Prospective evaluation of 49 patients (mean age 51 years) with minimum 15-year follow-up.
- Utilized physical examination, imaging (radiographs, ultrasound), and patient-reported outcome measures (PROMs).
- Statistical analysis to correlate preoperative/intraoperative factors with long-term outcomes.
Main Results:
- Significant, durable improvements in PROMs were observed, exceeding clinical importance thresholds.
- Male sex, traumatic tears, and smaller initial tear size were associated with better long-term outcomes.
- Structural deterioration occurred, but correlations with PROMs were weak; arthropathy showed weak links to pain and disability.
Conclusions:
- RCR in younger patients yields substantial and lasting functional improvements, even with structural decline.
- RCR may delay, but not halt, rotator cuff disease progression.
- Patients adapt to age-related structural changes post-RCR.
Background:
The long-term outcomes of rotator cuff repair (RCR) have not been well studied. The purpose of this study was to evaluate long-term functional and structural outcomes after RCR in younger patients.
Methods:
A total of 49 patients (34 [69%] male) with a mean age of 51 ± 6 years were evaluated preoperatively, and at short- and long-term follow-ups (minimum 15 years). There were 13 (27%) small, 17 (35%) medium, 14 (29%) large, and 5 (10%) massive tears. 15 (31%) had an acute repair of a traumatic tear. Long-term evaluation included physical examination, plain radiographs, ultrasound, and patient reported outcome measures (PROMs) (visual analog scale pain, Disability of Arm, Shoulder and Hand, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, and Short Form-36). Statistical analysis was performed to determine associations between preoperative and intraoperative factors and long-term functional and structural outcome.
Results:
There were significant improvements in the mean short- and long-term PROMs compared to preoperatively that exceeded reported minimal clinically important differences and substantial clinical benefits. There was a slight decrease in the PROMs from the short-term to long-term follow-up. Male sex and traumatic rotator cuff tears were associated with better long-term outcomes. The number of medical co-morbidities was associated with worse long-term outcomes. Smaller initial tear size was associated with better long-term outcomes. There were 15 (31%) full thickness and 9 (18%) partial thickness recurrent rotator cuff tears, 17 (35%) had rotator cuff tear arthropathy (2 Hamada grade 1, 15 Hamada grade 2), 5 (10%) had revision surgery (2 revision RCR, 2 anatomic total shoulder, and 1 reverse total shoulder), and 13 (26%) had subsequent contralateral RCR. There were weak correlations between the presence of arthropathy and DASH (r = 0.34; P = .02) and visual analog scale pain (r = 0.29; P = .049). There were no significant correlations between the structural outcomes (recurrent rotator cuff tear, recurrent full thickness tear, acromiohumeral space, and critical shoulder angle,) and the PROMs.
Discussion And Conclusion:
Long-term follow-up of RCR in this relatively young patient cohort demonstrated substantial and durable patient reported functional outcome and improvement despite considerable structural deterioration. This suggests that while RCR does not arrest the progression of rotator cuff disease it may delay this progression and that patients adapt to the structural changes as they age.
