Clinical Outcomes of Rotator Cuff Tear Repair in Patients ≤45 Years of Age: A Retrospective Analysis of 108 Patients

Abstract

Background: In the general population, the prevalence of rotator cuff tears (RCTs) is approximately 20.7%, with good clinical outcomes typically observed after rotator cuff repair (RCR). This prevalence is lower among patients ≤45 years of age. However, younger patients often have higher expectations after RCR. Despite this, few studies have specifically focused on this population. Purpose/Hypothesis: The purpose of this study was to evaluate the clinical outcomes of patients ≤45 years of age after full-thickness RCR. It was hypothesized that RCR improves pain score, strength, and clinical score significantly in this age group. Study Design: Case series; Level of evidence, 4. Methods: The authors retrospectively analyzed the records of patients aged ≤45 years at the time of surgery who underwent arthroscopic repair of a full-thickness RCT from 2011 to 2022 in 10 institutions by senior shoulder surgeons. Exclusion criteria were partial tears, revision surgery, and follow-up <1 year. Clinical follow-ups were conducted at 12, 24, and 120 months postoperatively, including evaluations of pain using the visual analog scale (VAS) score, range of motion, strength in abduction, and Constant-Murley score assessments. Additionally, the complication rate and the duration of preoperative symptoms were recorded. Results: The authors retrospectively included 108 shoulders in 108 patients ≤45 years of age at the time of surgery who underwent full-thickness arthroscopic repair by senior fellow-trained shoulder surgeons. A double-row repair was performed in 40% of cases; otherwise, a single-row repair was performed for posterosuperior RCTs. The mean age was 40.5 years, and 66% were men, with a mean follow-up of 2.4 years. Tears were traumatic in 41% of cases. Patients were employed in 97% of cases: 19% were office workers, 46% were light manual workers, and 32% were heavy workers. The VAS score, forward elevation, external and internal rotation, Constant score, and strength had all significantly improved at 1 year postoperatively. The mean Constant score gain was 30.0 in patients with a traumatic tear and 21.0 in patients with a degenerative tear (P = .001). The increase between preoperative and postoperative Constant scores was higher in patients with symptoms for <6 months at the time of surgery than in patients with symptoms for ≥6 months at the time of surgery (P = .023). Few (8.3%) complications were observed; most of them (8 patients) were postoperative stiffness that needed a specific treatment, and 1 patient had a symptomatic retear. In multivariate analysis, shoulder trauma was associated with higher postoperative Constant scores (P = .0042). Work-related tear was associated with lower Constant scores at 1 year (P = .0301). Conclusion: Patients ≤45 years of age with RCT generally have a good clinical outcome with improvement of pain and Constant score after arthroscopic repair. Degenerative tears and manual work are associated with poorer but acceptable outcomes.