What did the study look at?
Frailty is defined as a decline in the body's physiological and biological reserves that does not correspond directly to calendar age. The authors note that as life expectancy rises, more older adults take part in sport and sports injuries in this group are becoming more common. Frailty has been studied extensively in hip fracture and joint replacement, but what sports and shoulder surgeons need to know about it has received little attention. This paper aims to fill that gap.
How was it done?
This is a review; no new patient data were collected, and existing publications on the topic were brought together and interpreted. The paper covers models of frailty and its links with age, pain, muscle loss, nutrition, bone loss, multiple medications and delirium, followed by the periods before, during and after surgery.
What did it find?
The main points reported in the review are:
- How common: about 10% of people over 65 and 25%-50% of those over 85 show some degree of frailty, although these figures vary with the population and the method of assessment.
- Stronger than age: the studies cited show that frailty predicts clinical outcomes more strongly than age alone. The tool most used in orthopaedics is the 5-item modified Frailty Index (mFI-5).
- Shoulder: in a study of more than 300 patients who had rotator cuff repair, frail patients reported worse patient-reported outcomes and higher pain scores.
- Knee: according to the authors, no study has directly examined the effect of frailty on outcomes after osteotomy around the knee or cruciate ligament reconstruction. In data from 3,797 patients with multi-ligament knee injuries, frailty was the most significant predictor of length of stay and complications.
- Related conditions: muscle loss (sarcopenia), malnutrition, low bone density and use of multiple medications are linked with frailty in both directions; the authors note these may affect, for example, anchor fixation and tendon-to-bone healing.
- During and after surgery: the review highlights sensitivity to anaesthetic drugs, the risk of low body temperature (hypothermia) and delirium, and the need for carefully individualised rehabilitation. The authors also draw attention to "social frailty", which reflects a patient's ability to keep to treatment and rehabilitation.
The authors' conclusion
The authors conclude that frailty scales can be used to assess a patient's condition before surgery, anticipate difficulties during the operation and predict the risk of complications, illness and death afterwards. These tools can help sports surgeons understand a patient's functional capacity and resilience independently of calendar age. They stress that frailty is modifiable and manageable, which calls for individualised care planning.
Limitations
- This is a review, and its conclusions rest on the findings of other studies.
- The authors state that direct evidence on the effect of frailty in areas such as knee sports surgery, meniscal root repair and shoulder tendon transfers is lacking or limited, and that further research is needed.
Reference
Şahbat Y, Güner M, Gürsoy S. (2025). Frailty: An overlooked red flag in sports surgery. Journal of Experimental Orthopaedics, 12(4): e70497. Licence: CC BY 4.0.
DOI: 10.1002/jeo2.70497
Free full text: PubMed Central (PMC12583973)
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
