Are we misunderstanding rotator cuff lesions? - Age-based patterns of rotator cuff tears and their implications

This study explores how age affects the location, extent, and progression of rotator cuff (RC) lesions in shoulder arthroscopy patients, aiming to identify age-related patterns of injury from localized damage in younger patients to more extensive degeneration in older ones, guiding age-specific diagnostic and treatment strategies.

A prospective study of 487 shoulder arthroscopy patients (October 2019-September 2023) categorized cases into < 55 and ≥ 55 years. SLAP lesions, pulley injuries, RC tears (Lafosse and Bateman), and rotator cable damage were systematically documented. All surgeries followed standardized protocols by a single surgeon. Statistical analyses (Pearson correlation, Chi-squared tests) assessed age-related RC pathology associations, with significance set at α = 0.05.

Among 487 shoulder arthroscopies (mean age: 57.38 years), younger patients (< 55 years) had higher rates of medial (95.2%) and lateral (95.9%) pulley lesions, while older patients (≥ 55 years) exhibited significantly more advanced pathology, including lateral pulley lesions (100%), high-grade subscapularis tears (p < 0.0001), Bateman III-IV cuff tears (p < 0.0001), and combined cable tears (p < 0.0001). Medial pulley lesions correlated strongly with SLAP tears (r = 0.609), and age was positively associated with advanced injuries (r = 0.509) and negatively with partial subscapularis tears (r = - 0.143), indicating an age-related progression in rotator cuff degeneration.

The study suggests that lesions of the shoulder possibly arise from the biceps pulleys and extend more posteriorly. Distinct age-based patterns of RC pathology highlight the progression from localized injuries in younger patients to extensive degenerative damage in older individuals. These findings underscore the need for age-specific diagnostic and treatment strategies.