Arthroscopic Partial Repair and Arthroscopic Debridement Improve Pain and Functional Outcomes in Older Patients With Massive Irreparable Rotator Cuff Tears: A Systematic Review

Purpose To evaluate the current evidence on patient‐reported outcomes and complications after arthroscopic partial repair and arthroscopic debridement for massive irreparable rotator cuff tears (MIRCTs) in patients aged 65 years or older. Methods A systematic search of MEDLINE, Embase, and Cochrane Library databases was conducted through September 2025 according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Eligible studies included randomized controlled trials, cohort studies, and case series (>10 patients) reporting outcomes of arthroscopic partial repair or debridement in patients aged ≥65 years with minimum 12‐month follow‐up. Two reviewers independently extracted data and assessed study quality using Cochrane Risk of Bias 2.0 (RoB 2.0) and Risk Of Bias In Nonrandomized Studies of Interventions (ROBINS‐I) tools. Results Twenty‐six studies (n = 942 patients) were included. Both interventions led to clinically meaningful improvements in pain and function. Mean visual analog scale pain score improvements ranged from 2.0 to 5.8 with partial repair and 4.0 to 6.5 with debridement. Mean Constant‐Murley score gains ranged from 15.0 to 33.6 with partial repair and 16.4 to 31.4 with debridement. Retear rates after partial repair were high (41.7%‐87.3%) but not consistently associated with worse outcomes. Rates of infection and conversion to reverse shoulder arthroplasty were low across both interventions. Conclusions Arthroscopic partial repair and arthroscopic debridement are both effective joint‐preserving options for managing massive irreparable rotator cuff tears in older patients, resulting in significant improvements in pain and function, with low complication rates. Level of Evidence Level IV, systematic review of Level I to IV studies.