Strong evidence supports that older age is associated with higher failure rates and poorer patient reported outcomes after rotator cuff repair.

Management of Rotator Cuff Injuries
Endorsed by: AANA, ASES, AOSSM, ASSET, APTA
Strong Evidence STRONG EVIDENCE
Rationale
Three high quality studies (Deniz 2014, Park 2015, Rashid 2017) demonstrated higher re-tear rates are associated with advanced age.    Four high quality studies (Chung 2012, Deniz 2014, Kim 2016, Robinson 2013) demonstrated worse patient reported outcomes in patients with older age.

Risks and Harms of Implementing this Recommendation
While older age is associated with higher failure rates and poorer patient reported outcomes, age alone should not be used as a contraindication for rotator cuff repair, as failure to heal is related to multiple features.  Older patients should be counseled that they would be at increased risk for failure and poorer outcomes than younger patients who undergo rotator cuff repair.

Future Research
Degenerative rotator cuff disease is a phenomenon of aging, yet there is great variability in this phenomenon.  Future research is needed to distinguish chronological age from physiologic age, and healing will likely improve when age related changes to the rotator cuff are better understood and manipulated.
  1. Chung, S. W., Park, J. S., Kim, S. H., Shin, S. H., Oh, J. H. Quality of life after arthroscopic rotator cuff repair: evaluation using SF-36 and an analysis of affecting clinical factors. American Journal of Sports Medicine 2012; 3: 631-9
  2. Deniz, G., Kose, O., Tugay, A., Guler, F., Turan, A. Fatty degeneration and atrophy of the rotator cuff muscles after arthroscopic repair: does it improve, halt or deteriorate?. Archives of Orthopaedic & Trauma Surgery 2014; 7: 985-90
  3. Kim, D. H., Jang, Y. H., Choi, Y. E., Lee, H. R., Kim, S. H. Evaluation of Repair Tension in Arthroscopic Rotator Cuff Repair: Does It Really Matter to the Integrity of the Rotator Cuff?. American Journal of Sports Medicine 2016; 11: 2807-2812
  4. Park, J. S., Park, H. J., Kim, S. H., Oh, J. H. Prognostic Factors Affecting Rotator Cuff Healing After Arthroscopic Repair in Small to Medium-sized Tears. American Journal of Sports Medicine 2015; 10: 2386-92
  5. Rashid, M. S., Cooper, C., Cook, J., Cooper, D., Dakin, S. G., Snelling, S., Carr, A. J. Increasing age and tear size reduce rotator cuff repair healing rate at 1 year. Acta Orthopaedica 2017; 6: 606-611
  6. 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 re-tear. Bone & Joint Journal 2013; 2: 199-205