It seems that the age of 60 years is a sort of threshold for developing a rotator cuff tear. This concept arises from previous studies in which a significant proportion of patients over the age of 60 years have a rotator cuff tear [6, 7, 11]. The authors reported the results by using different tools, such as magnetic resonance and ultrasound. Obviously the adopted methodologies have been widely accepted in orthopedic community, with ultrasound comparable to magnetic resonance and arthrography [6, 15], but the validity of an arthroscopic evaluation is certainly superior. All patients evaluated in this study had the arthroscopic evaluation of tear dimensions. Such a potential limitation present in other studies has been overcome. In addition, correlation with cuff tear size was unavailable in these studies; only a retrospective study of 2006 with a huge number of patients affected by cuff tear (588) examined ultrasonographically the correlation between tear dimension (in mm) and age, with age not significantly related to the size of the tear in shoulders with or without pain [11]. In this study, we analyzed a large cohort of patients comparable to those of Yamagouchi et al. [11] with a symptomatic rotator cuff tear and undergoing surgery. As it is an observational study, we were not able to obtain scientific data about time elapsed from the beginning of the symptomatology, and, more interestingly, when their rotator cuff initially torn which resulted in not having direct data of progression of tear dimension over time, however, previous literature can support our concept. In fact, the tear size in both symptomatic [16] and asymptomatic [8] cuff tear patients, nonoperatively treated, was increased, and there was a greater probability of increasing the tear size in older patients rather than in younger ones. Considering that all patients of this study requested surgery and that it is current practice in our institution to operate only symptomatic patients, it is conceivable that being the most of the cohort with an at least large tear older than 65 years aging is directly correlated with cuff tears size dimensions. Certainly, there are other factors working in the progression of a cuff tear that might be related to the patient’s age. Cardiovascular disease and comorbidities in general [17], cigarette smoking [18], and tendon hypovascularity [19, 20] compromise the tendon and cause degeneration of the tendon itself; moreover, each of the mentioned factors, adjusted for age and gender, coparticipate in the most common tendinous injury in the adult population.