Arthroscopic Primary Rotator Cuff Repairs in Patients Aged Younger Than 45 Years
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Previous studies have reported the prevalence of rotator cuff tears in the general populace to be between 9.4% and 39.0%, with an increasing frequency in older individuals. Although pathology of the rotator cuff is typically related to a degenerative etiology, there is a subset of young patients who have rotator cuff injury, often related to trauma. A study by Yamamoto reported an incidence of 5.1% for persons aged between 20 and 50 years. In a magnetic resonance imaging (MRI) assessment of asymptomatic shoulders, Sher found a 4% rotator cuff tear rate in shoulders in patients aged younger than 40 years. Milgrom used ultrasound assessment and found no full-thickness tears, but partial-thickness tears were identified in 8% of patients aged between 30 and 50 years. Arthroscopic approaches for surgical management of rotator cuff injuries are well documented as having similar outcomes to or better outcomes than open techniques, with reproducible outcomes reported in multiple studies, generally with a mean patient age older than 50 years. However, few studies have reported clinical outcomes after arthroscopic repair in a younger patient population.
Young patients have several biologic and mechanical factors favoring a successful rotator cuff repair. Meyer have shown that osteoporotic bone can be 1 of several weak links of surgical repair in rotator cuff surgery, a factor seldom found in a younger population.
In addition, tendon quality and vascular supply are improved in younger patients. However, younger patients place higher demands on their shoulders, which may lead to impaired subjective or functional outcomes after repair. To our knowledge, there have only been 2 small cohorts that evaluated outcomes of arthroscopic rotator cuff repair of full-thickness tears in young populations. In patients aged younger than 40 years with cuff tears of traumatic etiology, Krishnan found that repairs resulted in excellent pain relief and return to preinjury levels of function. Satisfactory post-operative forward flexion and external rotation were reported, but it is unclear whether these findings represented improvements over baseline status because these data were lacking. Burns and Snyder examined patients aged younger than 50 years and reported a 97% patient satisfaction rate, with no significant loss of motion postoperatively. Other studies reporting on long-term outcomes of open rotator cuff repair in young patients have shown significant pain relief but limited return to function.
The purpose of this study was to evaluate the mechanism of injury and short-term clinical outcomes after arthroscopic primary rotator cuff repair in patients aged younger than 45 years. Our hypothesis was that the majority of patients younger than 45 would have larger, traumatic rotator cuff tears, but that after arthroscopic repair of full-thickness tears, they would have excellent functional outcomes and minimal pain.