Partial articular supraspinatus tendon avulsion: Should we repair? A systematic review of the evidence

Abstract

Introduction Partial articular sided rotator cuff tears are described as being a common cause of shoulder pain and to have a significant impact of patient quality of life. The natural history of partial articular supraspinatus tendon avulsion lesions is not clearly defined and there is limited evidence to determine optimal management. Aims To perform a systematic review of the literature regarding the evidence for partial articular supraspinatus tendon avulsion repair and to determine whether there is any difference between operative and non-operatively managed patients. Methods Conventional and grey literature were searched with defined terms to identify studies in human adults concerning management of partial articular sided supraspinatus avulsions. Results Out of 86 papers identified by the search terms, 28 were deemed eligible for review including 1966 shoulders. 4/28 papers were of level I–II evidence but all were comparing techniques. 4/28 papers were biomechanical cadaveric studies, assessing strength of repair and effect on stability. The remaining 20 studies were level IV–V evidence and consisted of case series and technical notes identifying varying techniques of repair and their outcomes. Conclusion Current literature suggests that all techniques used to repair partial articular supraspinatus tendon avulsion lesions give increased functional scores and reduced pain. However, this represents a heterogeneous group of patients with variable degrees of tear and is not reproducible. There are limited controlled studies to determine whether partial articular supraspinatus tendon avulsion lesions require repair. Current classification systems represent a single plane and are open to user variation. No evidence exists to determine which tears are stable and which may progress.

Transtendon Suture Bridge Repair of Both-Sided Partial-Thickness Rotator Cuff Tears: Midterm Outcomes

“…A recent systematic review showed that no evidence exists to determine which tears are stable and which may progress in the partial articular side rotator cuff tears. 41 However, both-sided partial tears should be differently approached, and transtendon suture bridge repair showed favorable outcomes at the midterm follow-up in our study. 41 The strength of our study is that arthroscopy confirmed the presence of both-sided PTRCT among the symptomatic PTRCT, and the integrity of the rotator cuff at a mean of 11 months postoperatively was assessed on MRI scans according to the Sugaya classification, which can be used to objectively grade the repair status.…”

“…41 However, both-sided partial tears should be differently approached, and transtendon suture bridge repair showed favorable outcomes at the midterm follow-up in our study. 41 The strength of our study is that arthroscopy confirmed the presence of both-sided PTRCT among the symptomatic PTRCT, and the integrity of the rotator cuff at a mean of 11 months postoperatively was assessed on MRI scans according to the Sugaya classification, which can be used to objectively grade the repair status. In a study of 249 cadavers, 13% had partial-thickness tears, in which 18% were bursal, 27% were articular, and 55% were intratendinous partial tears.…”

All-Inside Arthroscopic Partial Articular-Sided Supraspinatus Tendon Avulsion (PASTA) Repair Without Bunching of the Bursal Side of the Tendon

“…Several systematic reviews have shown that both techniques can improve shoulder function in the same way. 13 , 14 , 15 The advantages of trans-tendon repair are the preservation of the intact tendon and superior biomechanical strength. 10 , 11 However, there is a risk that the tendon will become overtensioned and that the technique will create tendon bunching on the bursal side, resulting in imbalanced tendon tension.…”

“… 12 Nevertheless, systematic reviews have shown that both techniques can improve shoulder function in the same way. 13 , 14 , 15 We propose an all-inside arthroscopic trans-tendon repair technique of PASTA lesion without bunching of the bursal side of the tendon.…”

Biceps Augmentation Outperforms Tear Completion Repair or In Situ Repair for Bursal-Sided Partial-Thickness Rotator Cuff Tears in a Rabbit Model

“…Partial-thickness rotator cuff tears (PTRCTs) are common injuries that may cause pain through normal range of motion and shoulder dysfunction in affected patients. 24,36 Over 70% of patients undergoing surgical treament for rotator cuff tears were diagnosed with PTRCTs through arthroscopy, and the overall prevalence rate of PTRCTs in the population was 13% to 40% 24,28,33,40 ; however, the ideal repair techniques for bursal-sided PTRCTs remain controversial. 35,36 Two main techniques have been reported: conversion to a full-thickness tear followed by repair (tear completion repair [TCR]) and in situ repair (ISR) with preservation of the remaining articular-sided tendon.…”