Are You Too Old for a Rotator Cuff Repair?

Rotator cuff tears increase with age and are particularly common in people over the age of 65. At the same time the ability to get the rotator cuff to heal after a repair decreases as we age. Many people use this information to argue that patients over the age of 70 should not have a rotator cuff repair.

What the evidence shows

However, an article in the May 2014 issue of the Arthroscopy Journal demonstrated good results following a rotator cuff repair in patients over the age of 70. The authors reviewed 238 rotator cuff repairs and compared results in patients aged 60 to 69 to those aged 70 to 79. Importantly, all patients attempted 6 months of conservative treatment (i.e. therapy, anti-inflammatories, injection). Overall, the patients had substantial improvement in function. There was no difference in the functional outcomes or healing rates between the two groups. Only increasing tear size (a larger tear) was related to a lack of tendon healing.

How I approach this in practice

In my practice, I advise an initial attempt at conservative treatment for patients over the age of 70 with a non-traumatic rotator cuff tear. Anti-inflammatories, a strengthening program, and injection under ultrasound (when pain impacts quality of life) are the mainstays of treatment. However, for patients who do not respond to this treatment, I consider arthroscopic rotator cuff repair.

Age alone can no longer be considered a barrier to rotator cuff repair. The fact is that patients are remaining active later into life and are living longer. Many patients in their 70s are very healthy and want to continue activities such as golf and tennis. For these types of patients I consider arthroscopic rotator cuff repair if an initial attempt at conservative treatment is not successful.