Rotator cuff tears in elderly patients: Is repair worthwhile?

Abstract

The global population is aging at an unprecedented rate. In the next 15 years, the population of individuals aged 60 years and older is projected to more than double. However, many older patients continue to participate in and enjoy active lifestyles, and accordingly seek and expect optimal treatment when physical limitations manifest. Degenerative lesions of the shoulder, such as rotator cuff tears (RCTs), increase in prevalence with age and may limit patient's active lifestyles. Although, rotator cuff (RC) lesions have been described as a normal occurrence with aging, and most patients are asymptomatic; some may experience pain and disability necessitating treatment. Most patients with symptomatic RCTs respond well to nonoperative treatment; however, conservative management is not sufficient for symptom relief in all. Historically, it has been debated whether to repair RCTs in the elderly, due to high re-tear rates reported in early literature. As the understanding of RC pathology in this group of patients has evolved in the past decade, advances in diagnosis, patient selection, perioperative management and surgical techniques have led to more sophisticated treatment strategies. In this review we aim to provide the reader with a comprehensive overview of current literature, starting with epidemiology and ending with the rehabilitation of RCTs in the elderly.