The Effect of Age on Risk of Retear After Rotator Cuff Repair. a Systematic Review and Meta-analysis

The Effect of Age on Risk of Retear after Rotator Cuff Repair: A Review of Prospective Randomized Controlled Studies


Rotator cuff injuries are a common cause of shoulder pain and dysfunction, often necessitating surgical intervention. Age, a non-modifiable risk factor, is thought to influence the probability of retear after rotator cuff repair (RCR). This statement reviews prospective randomized controlled studies to shed light on the impact of age on the risk of retear following RCR.


A comprehensive search of PubMed, Embase, and Cochrane Library databases was conducted for prospective randomized controlled trials (RCTs) that studied the relationship between age and rotator cuff retear post-surgery. Studies were selected that used imaging techniques like MRI or ultrasound to confirm retears and stratified outcomes by age. Both arthroscopic and open techniques for repair were considered.

Study Findings

Multiple RCTs confirm a positive association between advancing age and higher retear rates following RCR. For instance, a 2022 study found that patients above 65 years had significantly higher retear rates than those below 65, suggesting that age influences structural tendon healing after surgery. Another RCT conducted in 2023 revealed a trend towards increased retear rates in patients aged 70 and above, suggesting a possible age cut-off for increased risk.

Impact of Age on Healing Process

Age-related changes in tendon properties might be responsible for this increased retear risk. Studies suggest a decline in tendon vascularity, cellularity, and collagen synthesis with age, all of which could impede the healing process post-surgery. Furthermore, a common condition among the elderly, degenerative tendinopathy, reduces the tendon’s capacity to heal and remodel after injury, which could contribute to the higher retear rates.

Age-related Comorbidities

Several age-related comorbidities such as diabetes, cardiovascular disease, and osteoporosis are associated with poorer healing outcomes after RCR. For instance, osteoporosis has been linked to lower rotator cuff repair success rates due to decreased bone quality. As these conditions are more common in the elderly, they might indirectly influence retear rates in this population.

Consideration of Treatment Modality

Research also suggests that the choice of surgical method can influence retear rates in older patients. Arthroscopic repair, being less invasive, has been associated with lower retear rates compared to open repairs, especially in older patients. Therefore, arthroscopy might be a preferred surgical technique in this age group.


Age appears to be a significant determinant of retear risk after RCR, with older age associated with higher retear rates. This can be attributed to age-related changes in tendon properties, higher prevalence of comorbidities, and the chosen surgical method. These findings necessitate personalized postoperative strategies for older patients, including enhanced physical therapy and possibly more rigorous follow-up to ensure optimal surgical outcomes. Further research is warranted to better understand the mechanisms underlying the influence of age on post-RCR healing and to develop strategies to mitigate retear risk in older patients.

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© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow