By 2050, Arthroscopic Rotator Cuff Repairs Will Double While Open Repairs Will Decline to One-Fifth Based on United States Medicare Patients Aged 65 or Older.

Abstract

To project the future utilization of open and arthroscopic rotator cuff repair (RCR) in the Medicare population through 2050, incorporating post-COVID recovery data to provide insight into evolving surgical preferences, economic pressures, and implications for health care delivery. We analyzed 2003-2024 data from the Centers for Medicare and Medicaid Services Medicare Part-B National Summary, which captures all Medicare beneficiaries undergoing open or arthroscopic RCR as identified by Current Procedural Terminology codes. Projections were based on 2003-2019 and 2023-2024 data, reflecting post-COVID-19 recovery and avoiding distortions from 2020 to 2022 pandemic-related disruptions. Statistical models evaluated included log-linear, Poisson, negative binomial, and autoregressive integrated moving average. Autoregressive integrated moving average was selected based on the lowest normalized root mean square error, reflecting superior predictive accuracy and its ability to capture time-dependent trends, and was used to forecast RCR volumes through 2050. In 2024, there were 23,154 open and 188,700 arthroscopic RCR procedures, which served as the baseline for modeling. Open RCR is projected to decline on average by 5.91% annually, while arthroscopic RCR is projected to grow by 2.88% annually. By 2050, arthroscopic RCR volume is expected to reach 394,434 procedures (95% forecast interval: 363,424-425,321), whereas open RCR is expected to decline to 4748 procedures (95% forecast interval: 1243-43,747). Autoregressive integrated moving average modeling projects that by 2050 arthroscopic RCR utilization will increase by 2-fold and open RCR will decline to one-fifth compared with 2024 baseline volumes. Level III, retrospective cohort study.