Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2018

01-01-2018 | Shoulder

Improved outcomes with arthroscopic repair of partial-thickness rotator cuff tears: a systematic review

Authors: J. Christoph Katthagen, Gabriella Bucci, Gilbert Moatshe, Dimitri S. Tahal, Peter J. Millett

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2018

Login to get access

Abstract

Purpose

The optimum treatment strategy for the surgical management of partial-thickness rotator cuff tears (PTRCT) is evolving. In this study, two research questions were sought to be answered: “Does the repair technique for PTRCTs involving >50% of the tendon thickness have an effect on structural and functional outcomes of arthroscopic repair?” and “Is there a difference in outcomes of arthroscopically treated articular- and bursal-sided PTRCTs?”.

Methods

A systematic review according to the PRISMA statement was conducted to identify all literature published reporting on outcomes of arthroscopic treatment of PTRCTs classified with the Ellman classification with minimum 2-year follow-up. Prospective randomized trials were eligible for quantitative synthesis. A total of 19 studies, published between 1999 and 2015, met the inclusion criteria of this systematic review. Two studies reporting outcomes of articular-sided PTRCTs with prospective randomized study design were included in quantitative synthesis calculations.

Results

Arthroscopic repair of PTRCTs >50% thickness results in significant pain relief and good to excellent functional outcomes. When in situ repair was compared with repair of the tendon after completion to full-thickness RCT, there were no significant differences in functional or structural outcomes or complication rates. The best treatment method for low-grade PTRCTs remains unclear.

Conclusions

The repair technique (in situ repair versus repair of the tendon after completion to full-thickness RCT) did not significantly affect the outcomes for arthroscopic repair of PTRCTs >50% thickness. The current literature contains evidence for inferior outcomes and higher failure rates after arthroscopic debridement of bursal-sided compared to articular-sided PTRCTs, and some evidence suggests that repair of lower-grade bursal-sided tears may be beneficial over debridement.

Level of evidence

IV.
Literature
1.
Chang KV, Hung CY, Han DS, Chen WS, Wang TG, Chien KL (2015) Early versus delayed passive range of motion exercise for arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials. Am J Sports Med 43:1265–1273CrossRefPubMed
2.
Chung SW, Kim JY, Yoon JP, Lyu SH, Rhee SM, Oh SB (2015) Arthroscopic repair of partial-thickness and small full-thickness rotator cuff tears. Am J Sports Med 43:588–596CrossRefPubMed
3.
Connor PM, Banks DM, Tyson AB, Coumas JS, D’Alessandro DF (2003) Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. Am J Sports Med 31:724–727CrossRefPubMed
4.
Cordasco FA, Backer M, Craig EV, Klein D, Warren RF (2002) The partial-thickness rotator cuff tear: is acromioplasty without repair sufficient? Am J Sports Med 30:257–260CrossRefPubMed
5.
Curtis AS, Burbank KM, Tierney JJ, Scheller AD, Curran AR (2006) The insertional footprint of the rotator cuff: an anatomic study. Arthroscopy 22:603–609CrossRef
6.
Deutsch A (2007) Arthroscopic repair of partial-thickness tears of the rotator cuff. J Shoulder Elb Surg 16:193–201CrossRef
7.
Dugas JR, Campbell DA, Warren RF, Robie BH, Millett PJ (2002) Anatomy and dimensions of rotator cuff insertions. J Shoulder Elb Surg 11:498–503CrossRef
8.
Duralde XA, McClelland WB Jr (2012) The clinical results of arthroscopic transtendinous repair of grade III partial articular-sided supraspinatus tendon tears. Arthroscopy 28:160–168CrossRefPubMed
9.
Ellman H (1990) Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res 254:64–74
10.
Ellman H, Kay SP (1991) Arthroscopic subacromial decompression for chronic impingement. Two- to five-year results. J Bone Jt Surg Br 73:395–398
11.
Franceschi F, Papalia R, Del Buono A, Vasta S, Costa V, Maffulli N, Denaro V (2013) Articular-sided rotator cuff tears: which is the best repair? a three-year prospective randomized controlled trial. Int Orthop 37:1487–1493CrossRefPubMedPubMedCentral
12.
Fukuda H, Hamada K, Nakajima T, Tomonaga A (1994) Pathology and pathogenesis of the intratendinous tearing of the rotator cuff viewed from en bloc histologic sections. Clin Orthop Relat Res 304:60–67
13.
Fukuda H, Hamada K, Nakajima T, Yamada N, Tomonaga A, Goto M (1996) Partial-thickness tears of the rotator cuff. A clinicopathological review based on 66 surgically verified cases. Int Orthop 20:257–265CrossRefPubMed
14.
Harris JD, Quatman CE, Manring MM, Siston RA, Flanigan DC (2014) How to write a systematic review. Am J Sports Med 42:2761–2768CrossRefPubMed
15.
Kamath G, Galatz LM, Keener JD, Teefey S, Middleton W, Yamaguchi K (2009) Tendon integrity and functional outcome after arthroscopic repair of high-grade partial-thickness supraspinatus tears. J Bone Jt Surg Am 91:1055–1062CrossRef
16.
Kartus J, Kartus C, Rostgård-Christensen L, Sernert N, Read J, Perko M (2006) Long-term clinical and ultrasound evaluation after arthroscopic acromioplasty in patients with partial rotator cuff tears. Arthroscopy 22:44–49CrossRefPubMed
17.
Kim KC, Shin HD, Cha SM, Park JY (2014) Repair integrity and functional outcome after arthroscopic conversion to a full-thickness rotator cuff tear: articular- versus bursal-side partial tears. Am J Sports Med 42:451–456CrossRefPubMed
18.
Koh KH, Shon MS, Lim TK, Yoo JC (2011) Clinical and magnetic resonance imaging results of arthroscopic full-layer repair of bursal-side partial-thickness rotator cuff tears. Am J Sports Med 39:1660–1667CrossRefPubMed
19.
Lo IK, Burkhart SS (2004) Transtendon arthroscopic repair of partial-thickness, articular surface tears of the rotator cuff. Arthroscopy 20:214–220CrossRefPubMed
20.
Lumsdaine W, Smith A, Walker RG, Benz D, Mohammed KD, Stewart F (2015) Morphology of the humeral insertion of the supraspinatus and infraspinatus tendons: application to rotator cuff repair. Clin Anat 28:767–773CrossRefPubMed
21.
Mall NA, Kim HM, Keener JD, Steger-May K, Teefey SA, Middleton WD, Stobbs G, Yamaguchi K (2010) Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables. J Bone Jt Surg Am 92:2623–2633CrossRef
22.
Maman E, Harris C, White L, Tomlinson G, Shashank M, Boyton E (2009) Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. J Bone Jt Surg Am 91:1898–1906CrossRef
23.
Mascarenhas R, Chalmers PN, Sayegh ET, Bhandari M, Verma NN, Cole BJ, Romeo AA (2014) Is double-row rotator cuff repair clinically superior to single-row rotator cuff repair: a systematic review of overlapping meta-analysis. Arthroscopy 30:1156–1165CrossRefPubMed
24.
Matthewson G, Beach CJ, Nelson AA, Woodmass JM, Ono Y, Boorman RS, Lo IK, Thornton GM (2015) Partial thickness rotator cuff tears: current concepts. Adv Orthop 2015:458786CrossRefPubMedPubMedCentral
25.
Millett PJ, Warth RJ, Dornan GJ, Lee TJ, Spiegl UJ (2014) Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. J Shoulder Elb Surg 23:586–597CrossRef
26.
Modi CS, Smith CD, Drew SJ (2012) Partial-thickness articular surface rotator cuff tears in patients over the age of 35: etiology and intra-articular associations. Int J Shoulder Surg 6:15–18CrossRefPubMedPubMedCentral
27.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341CrossRefPubMed
28.
Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C (2013) Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint? J Bone Jt Surg Br 95-B:935–941CrossRef
29.
Olsewski JM, Depew AD (1994) Arthroscopic subacromial decompression and rotator cuff debridement for stage II and stage III impingement. Arthroscopy 10:61–68CrossRefPubMed
30.
Park JY, Chung KT, Yoo MJ (2004) A serial comparison of arthroscopic repairs for partial- and full-thickness rotator cuff tears. Arthroscopy 20:705–711CrossRefPubMed
31.
Park JY, Yoo MJ, Kim MH (2003) Comparison of surgical outcome between bursal and articular partial thickness rotator cuff tears. Orthopedics 26:387–390PubMed
32.
Park SE, Panchal K, Jeong JJ, Kim YY, Kim JH, Lee JY, Ji JH (2015) Intratendinous rotator cuff tears: prevalence and clinical and radiological outcomes of arthroscopically confirmed intratendinous tears at midterm follow-up. Am J Sports Med 43:415–422CrossRefPubMed
33.
Peters KS, McCallum S, Briggs L, Murrell GA (2012) A comparison of outcomes after arthroscopic repair of partial versus small or medium-sized full-thickness rotator cuff tears. J Bone Jt Surg Am 94:1078–1085CrossRef
34.
Porat S, Nottage WM, Fouse MN (2008) Repair of partial thickness rotator cuff tears: a retrospective review with minimum two-year follow-up. J Shoulder Elb Surg 17:729–731CrossRef
35.
36.
Ruotolo C, Fow JE, Nottage WM (2004) The supraspinatus footprint: an anatomic study of the supraspinatus insertion. Arthroscopy 20:246–249CrossRefPubMed
37.
38.
Shin SJ (2012) A comparison of 2 repair techniques for partial-thickness articular-sided rotator cuff tears. Arthroscopy 28:25–33CrossRefPubMed
39.
Shin SJ, Kook SH, Rao N, Seo MJ (2015) Clinical outcomes of modified mason-allen single-row repair for bursal-sided partial-thickness rotator cuff tears: comparison with the double-row suture-bridge technique. Am J Sports Med 43:1976–1982CrossRefPubMed
40.
Wang Y, Lu L, Lu Z, Xiao L, Kang Y, Wang Z (2015) Arthroscopic transtendinous repair of articular-sided pasta (partial articular supraspinatus tendon avulsion) injury. Int J Clin Exp Med 8:101–107PubMedPubMedCentral
41.
Weber SC (1999) Arthroscopic debridement and acromioplasty versus mini-open repair in the treatment of significant partial-thickness rotator cuff tears. Arthroscopy 15:126–131CrossRefPubMed
42.
Woods TC, Carroll MJ, Nelson AA, More KD, Berdusco R, Sohmer S, Boorman RS, Lo IK (2014) Transtendon rotator-cuff repair of partial-thickness articular surface tears can lead to medial rotator-cuff failure. Open Access J Sports Med 5:151–157PubMedPubMedCentral
43.
Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Jt Surg Am 85-A:1–3CrossRef
44.
Xiao J, Cui GQ (2015) Clinical and magnetic resonance imaging results of arthroscopic repair of intratendinous partial-thickness rotator cuff tears. Chin Med J (Engl) 128:1496–1501CrossRef
45.
Xiao J, Cui G (2015) Clinical and structural results of arthroscopic repair of bursal-side partial-thickness rotator cuff tears. J Shoulder Elb Surg 24:e41–e46CrossRef
46.
Yamanaka K, Matsumoto T (1994) The joint side tear of the rotator cuff. A followup study by arthrography. Clin Orthop Relat Res 304:68–73
Metadata
Title
Improved outcomes with arthroscopic repair of partial-thickness rotator cuff tears: a systematic review
Authors
J. Christoph Katthagen
Gabriella Bucci
Gilbert Moatshe
Dimitri S. Tahal
Peter J. Millett
Publication date
01-01-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4564-0

Other articles of this Issue 1/2018

Knee Surgery, Sports Traumatology, Arthroscopy 1/2018 Go to the issue

Shoulder

Arthroscopic management of suprascapular neuropathy of the shoulder improves pain and functional outcomes with minimal complication rates

Spine

Disc degeneration on MRI is more prevalent in young elite skiers compared to controls

Shoulder

Return to sport after shoulder arthroplasty: a systematic review and meta-analysis

Shoulder

Risk of fracture of the acromion depends on size and orientation of acromial bone tunnels when performing acromioclavicular reconstruction

Shoulder

Concomitant coracoplasty during arthroscopic subscapularis repair does not yield better clinical outcomes and structural integrity

Shoulder

Arthroscopic posterior bone block stabilization-early results of an effective procedure for the recurrent posterior instability