Partial-thickness Articular Surface Rotator Cuff Tears: An All-inside Repair Technique

Spencer, Edwin E.

doi:10.1007/s11999-009-1215-x

Cited by 53 publications

(36 citation statements)

References 24 publications

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“…12 The described technique allows the surgeon to visualize the bursal side of the cuff while adjusting the tension on the sutures through the knotless suture anchor before final insertion of the anchor. The ability to visually gauge the tension on the bursal side of the cuff allows us to avoid overtensioning of this surface and may contribute to less postoperative stiffness.…”

Section: Discussionmentioning

confidence: 99%

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A Novel Arthroscopic Inside-Out Repair Technique for PASTA Lesions

Caldwell

Elfar

2014

Arthroscopy Techniques

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There is no current consensus in the literature on the optimal technique for surgical treatment of partial articular-sided supraspinatus tendon avulsion (PASTA) lesions, although most techniques described to date require takedown of the partially torn tendon or passage of an anchor through the already damaged tendon. We describe a novel inside-out repair technique for partial articular surface supraspinatus tears that does not require further disruption of the partially torn tendon by passage of an anchor.P artial-thickness rotator cuff tears (PTRCTs) have long been recognized as distinct from full-thickness rotator cuff tears. They have been noted in as many as 26% of asymptomatic patients aged 40 to 60 years 1 but can present with a wide spectrum of symptoms including a higher level of reported pain than fullthickness tears. 2 They have also been noted to occur in the younger population, particularly overhead throwing athletes. 3 Only recently, however, has the literature recognized articular-sided PTRCTs as distinct from bursal-sided PTRCTs in both mechanism and potential treatment modalities. 4 Articular surface PTRCTs are reported 2 to 3 times more commonly than bursal-only PTRCTs in the literature. 5 More partial-thickness tears in older patients are articular-sided supraspinatus tears than bursal sided, and the most commonly reported tear in younger overhead throwing athletes is on the articular side at the supraspinatus-infraspinatus junction. 4 It has been noted that there is a relative hypovascularity of the articular surface of the supraspinatus tendon compared with the bursal surface, which may contribute to the higher incidence of degenerative tearing of the articular surface at the insertion of the supraspinatus. 6 The articular and bursal sides of the supraspinatus differ in their histology as well: The bursal side of the cuff contains mainly tendinous bundles, giving it a greater tensile strength, whereas the articular side is a more complex mixture of ligament, capsule, and tendon. 7 Although the initial treatment for most articular-sided PTRCTs is nonoperative and symptomatically oriented, the natural history of these lesions remains unclear. Cadaveric studies have shown an increase in strain on the remaining intact supraspinatus tendon during abduction when a 33% thickness partial articular-sided supraspinatus avulsion (PASTA) lesion is created, 8 and a serial arthrography study found that 27% of articular-sided tears progressed to full-thickness tears over a 1-year period whereas only 10% appeared to heal completely. 9 This finding suggests that even when nonoperative treatment is successful in resolving symptoms, it is unlikely that this represents healing of the tear. Failure of conservative management is considered an indication for surgical intervention.There is no consensus in the literature regarding the ideal technique for treatment of PASTA lesions, although many techniques have been described, including simple debridement, tear completion and complete repair, and a variety ...

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Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] As recently as 2010, there were no prospective studies and no randomized controlled trials that looked at the clinical outcomes of these different techniques for treatment of PASTA lesions, 14 suggesting that much research remains to be performed in this area.…”

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confidence: 99%

A Novel Arthroscopic Inside-Out Repair Technique for PASTA Lesions

Caldwell

Elfar

2014

Arthroscopy Techniques

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“…While this may provide a more anatomic repair, prospective data is lacking. Spencer et al performed a retrospective review of 20 patients who underwent all-inside intra-articular repair for grade III articular-sided lesions and found improved clinical outcome scores without major post-operative clinical stiffness [55].…”

Section: Partial-thickness Rotator Cuff Tearsmentioning

confidence: 99%

Partial and Full-Thickness RCT: Modern Repair Techniques

Nathani

Smith

Wang

2018

Curr Rev Musculoskelet Med

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Purpose of Review The purpose of this article is to review the recent literature concerning modern repair techniques related to partial-and full-thickness rotator cuff tears. Recent Findings The understanding of rotator cuff pathology and healing continues to evolve, beginning with emerging descriptions of the anatomic footprint and natural history of rotator cuff tears. Significant controversy remains in treatment indications for partial-thickness rotator cuff lesions as well as optimal surgical repair techniques for both partial-and full-thickness tears. Techniques such as margin convergence and reduction of the so-called "comma" tissue have improved the ability to anatomically reduce large and retracted tears. Repair strength and contact pressures are improved with double-row repairs and transosseusequivalent techniques compared to traditional single-row repairs. Future work is directed towards obtaining reliable radiographic healing and demonstrating clinical superiority and cost-effectiveness of a single technique. Summary Much recent work regarding rotator cuff anatomy and pathology has been reported. Newer techniques improve repair strength. Despite these advances, significant questions remain concerning surgical indications and clinical outcomes.

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“…In 2010 Spencer [14], in his concern regarding the transtendinous techniques that can be associated with stiffness and also knowing that completing the tear takes down normal intact tissue, developed a technique that repairs the articular-side partial-thickness rotator cuff tears with an all-inside approach that does not violate the intact bursal tissue and does not complete the tear.…”

Section: Introductionmentioning

confidence: 99%

Approaches for Arthroscopic Management in Partial Articular Rotator Cuff Tears - Literature Review

Bentolila¹

2017

MOJOR

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Partial-thickness Articular Surface Rotator Cuff Tears: An All-inside Repair Technique

Cited by 53 publications

References 24 publications

A Novel Arthroscopic Inside-Out Repair Technique for PASTA Lesions

A Novel Arthroscopic Inside-Out Repair Technique for PASTA Lesions

Partial and Full-Thickness RCT: Modern Repair Techniques

Approaches for Arthroscopic Management in Partial Articular Rotator Cuff Tears - Literature Review

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