Surgical Treatment Options for Partial Rotator Cuff Tears: A Review of the Literature

Abstract

Partial-thickness rotator cuff tears (PTRCT) can be articularsided, bursal-sided or intratendinous. New research suggests that a considerable proportion (up to 30%) of cuff thickness on the articular side is taken up histologically by the superior joint capsule conjoined to the rotator cuff tissue. This means that newer reviews of the surgical options may be required to complement the Ellman classification which grades lesions as grade 1 (less than 25% of tendon thickness involved), grade 2 (25-50%) or grade 3 (greater than 50% of tendon thickness). If primary non-operative treatment fails, many surgical options can be considered. The surgical technique chosen has been based on depth of the tear and the tear location. Surgical treatment can be distinguished between debridement and repair of PTRCT's, as well as biologically active experimental techniques showing some promise. Debridement can be successfully performed for bursal-sided Ellman grade 1 tears and articular-sided grade 1 and 2 tears. All other techniques show better results with a repair technique, which can be either performed with an in-situ or trans-cuff repair technique (leaving the intact rotator cuff portion intact) or with tear conversion to a full-thickness cuff tear and subsequent repair. Successful functional and structural outcome after repair of Ellman grade 3 tears can be shown with both repair techniques. The current literature also suggests evidence for inferior outcomes and higher failure rates after arthroscopic debridement of bursal-sided partial-thickness rotator cuff tears compared to articularsided lesions, which may reflect the contribution of capsule to the tear. Articular-sided partial cuff tears are frequently seen in overhead athletes and should be treated non-operatively whenever possible. If conservative treatment fails, debridement seems to be a better surgical choice in most cases, as only a half of professional athletes return to the same level of play after repair of partial-thickness rotator cuff tears.

High-Grade Bursal Side Rotator-Cuff Repair: A Surgical Outcome Review

“…Patients with a bursal side tear should be closely monitored for their response to nonoperative management, with consideration given to those with tears >50% of the thickness for early surgical intervention. 5 Tear size and depth, patient age and activity level, and cause of the tear also have to be considered. 6 , 7 The recommended treatment for bursal side tears includes debridement with or without acromioplasty for grade I tears (low grade) and rotator cuff–tendon repair for grade II and III tears (high grade).…”

Partial rotator cuff tears: algorithmic approach to treatment

“…Provided the guidelines initially proposed by Ellman are followed, the outcome of surgical repair of partial-thickness rotator cuff tears remains excellent, consistent with the outcome expected of surgical repair of small rotator cuff tears in general. For individuals who are not overhead throwing athletes, studies have shown low complication rates and good to excellent results in most cases ( 9 , 17 , 18 , 20 ).…”