Clinical Outcomes of Rotator Cuff Tear Repair in Patients ≤45 Years of Age: A Retrospective Analysis of 108 Patients
Orthopaedic journal of sports medicine · 2026
Young patients improve after cuff repair, but with no comparison group this case series can't tell you surgery beat the alternative.
Studien
Retrospective case series, n=108 shoulders in patients ≤45 years old undergoing arthroscopic full-thickness rotator cuff repair across 10 institutions.
Vad de fann
VAS pain, range of motion, strength, and Constant score all significantly improved at 1 year. Constant score gain averaged 30.0 points for traumatic tears versus 21.0 for degenerative tears (P=.001), symptom duration <6 months predicted a larger improvement than ≥6 months (P=.023), and complication rate was 8.3% (mostly stiffness, 1 retear).
Studiedesign
Level 4 case series, retrospective, multicentre (10 institutions), n=108, no comparison group. This sits low on the evidence hierarchy, one step above expert opinion or a single case report, and cannot support causal claims about repair versus alternatives.
Metodik
No control arm means the 'improvement' seen could partly reflect natural history, regression to the mean, or placebo/expectation effects rather than the surgery itself. Multiple surgeons and sites over an 11-year window (2011-2022) introduce technique and rehab heterogeneity, and retrospective chart review is vulnerable to missing data and selection bias (only patients with ≥1 year follow-up were included, which likely excludes early failures or dissatisfied patients lost to follow-up). No mention of blinded outcome assessment, which matters for a subjective score like Constant, and no power calculation is reported so subgroup comparisons (traumatic vs degenerative, work type) risk being underpowered despite reaching statistical significance. A clinician wanting to verify these findings would need to see the raw pre- to post-op Constant score distributions and loss-to-follow-up numbers, not just the reported means and p-values.
Granskningen
The pain and function gains are plausible and consistent with the broader rotator cuff repair literature, but with no comparator (non-operative care, or older patients) this study cannot say repair is better than alternatives in this age group, only that operated patients tend to improve. The traumatic-versus-degenerative and symptom-duration findings are statistically significant but describe associations in an uncontrolled cohort, not proven causal drivers of outcome, so they should be read as hypothesis-generating rather than practice-defining.
Begränsningen
There is no non-operative or older-age comparator arm, so it's impossible to know how much of the improvement is attributable to surgery specifically versus what physiotherapy alone might achieve in this younger, presumably healthier population.
Referensstudie
This extends the general rotator cuff repair outcomes literature (well established for older/typical populations) into an under-studied younger cohort, but it does not overturn or directly compare against any specific landmark RCT; it's descriptive natural-history data for a population gap rather than a test of a prior finding.
Vad du gör på måndag
For patients ≤45 with a confirmed full-thickness cuff tear, use this cohort's numbers as consent-conversation anchors rather than as a case for surgery over conservative care, which was never tested here. Two things are worth actually saying to the patient: expect a bigger Constant score gain if the tear is traumatic (mean +30) versus degenerative (mean +21, P=.001), and expect a bigger gain if repair happens within 6 months of symptom onset versus later (P=.023), the latter being a genuine 'don't sit on this too long once it's confirmed and surgery is the agreed plan' message rather than a push toward earlier surgery in general. Complication rate was a modest 8.3%, mostly stiffness with one retear, which is reassuring but not zero, so it belongs in the consent conversation too.
In practice
This applies to physically active adults ≤45 with a confirmed full-thickness cuff tear where surgery is already the agreed plan, not to partial tears, older patients, or as an argument for surgery over a conservative trial in the first place. In clinic, use the traumatic-vs-degenerative and symptom-duration findings as counseling anchors: a young patient with a traumatic tear symptomatic for 8 weeks can be told to expect a larger functional gain than one with an insidious-onset tear who's delayed for a year, and once a full-thickness tear and surgery are confirmed, that's an argument against letting the decision drag past 6 months, not an argument to skip conservative care altogether. On the performance floor this is post-op benchmarking, not a green light to accelerate: track forward elevation, ER/IR range and abduction strength against the Constant-score trajectory reported here, and remember 8.3% still had a complication (mostly stiffness, one retear), so 'young patients do well on average' shouldn't translate into faster overhead reloading for any individual athlete.
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