The Arthroscopic Management of Partial-Thickness Rotator Cuff Tears: A Systematic Review of the Literature

Strauss, Eric J.; Salata, Michael J.; Kercher, James S.; Barker, Joseph U.; McGill, Kevin C.; Bach, Bernard R.; Romeo, Anthony A.; Verma, Nikhil N.

doi:10.1016/j.arthro.2010.09.019

Cited by 156 publications

(135 citation statements)

References 41 publications

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“…5 However, controversy exists regarding the optimal surgical management. 2,3 This type of tear is often repaired by "completing" the tear via violation of the intact bursal rotator cuff tissue to access the pathologic intra-articular portion of the rotator cuff tendon.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 This type of tear is often repaired by "completing" the tear via violation of the intact bursal rotator cuff tissue to access the pathologic intra-articular portion of the rotator cuff tendon. 5 The tear is therefore converted into a full-thickness tear, and numerous repair techniques become applicable. Transtendon repair techniques were developed to avoid the morbidity of disrupting the patient's remaining bursal rotator cuff fibers during the repair.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Transtendon, Double-Row, Transosseous-Equivalent Arthroscopic Repair of Partial-Thickness, Articular-Surface Rotator Cuff Tears

Dilisio

Miller

Higgins

2014

Arthroscopy Techniques

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Arthroscopic transtendinous techniques for the arthroscopic repair of partial-thickness, articular-surface rotator cuff tears offer the advantage of minimizing the disruption of the patient's remaining rotator cuff tendon fibers. In addition, double-row fixation of full-thickness rotator cuff tears has shown biomechanical advantages. We present a novel method combining these 2 techniques for transtendon, double-row, transosseous-equivalent arthroscopic repair of partialthickness, articular-surface rotator cuff tears. Direct visualization of the reduction of the retracted articular tendon layer to its insertion on the greater tuberosity is the key to the procedure. Linking the medial-row anchors and using a double-row construct provide a stable repair that allows early shoulder motion to minimize the risk of postoperative stiffness.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transtendon, Double-Row, Transosseous-Equivalent Arthroscopic Repair of Partial-Thickness, Articular-Surface Rotator Cuff Tears

Dilisio

Miller

Higgins

2014

Arthroscopy Techniques

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“…Current knowledge indicates that partial articular-sided tears in excess of 50% of the tendon thickness are more effectively treated by rotator cuff repair. 3,4,[12][13][14] Sutures can be placed from front to back or back to front. Tying the suture closer to the tuberculum majus first will be more effective.…”

Section: Discussionmentioning

confidence: 99%

Rotator Cerclage Technique for Partial Rotator Cuff Ruptures

Bozkurt

Fırat

Gürsoy

et al. 2015

Arthroscopy Techniques

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The frequency of partial rotator cuff tears is gradually increasing because of the advancements in imaging methods and arthroscopy techniques. One of the repair techniques is repair of the partial rotator cuff tear by conversion to a full-thickness tear. Another technique, the transtendon technique, has some practical challenges and risks. We attempted to develop a practical and easy technique with low morbidity to repair partial tears called the rotator cerclage technique.T he level of knowledge and the rate of establishing a distinctive diagnosis for partial rotator cuff tears have increased in line with widespread adoption of humeral arthroscopy and advanced magnetic resonance imaging methods. The best treatment plan for symptomatic partial rotator cuff tears remains uncertain. 1 Previously, debridementdboth with and without acromioplastydwas the standard treatment, 2,3 but this is being replaced by the repair of lesions in excess of 6 mm (grade 3) or those larger than 50% of the tendon thickness. 4 The most recent debate is inclined toward the conversion from a partial-to full-thickness tear and repair of the tear 5,6 or transtendon repair. 7,8 Both methods result in functional recovery and relief, but repairing the tear results in lower morbidity and earlier recovery whereas the tendon integrity, native footprint, and biomechanical properties (gapping and mean ultimate failure strength) are better in the case of transtendon repair, which keeps the bursal side intact. 9 The transtendon repair techniques described so far involve some challenges in surgical implementation and require experience. Our goal is to develop a practical technique with easy implementation through which a partial tear can be repaired through interventions performed only from the bursal side without converting the tear to a full-thickness tear after the partial tear is identified intra-articularly (Table 1). TechniqueAfter induction of anesthesia, the patient is placed in the beach-chair position. A standard diagnostic arthroscopy is performed with 30 arthroscopic visualization through a posterior portal with a pump (FMS DUO Fluid Management System; DePuy Mitek, Raynham, MA) maintaining a pressure of 50 mm Hg. The supraspinatus insertion to the humerus is inspected in the neutral position with abduction and external rotation of the arm because most tears can be clearly seen at this position (Fig 1). After examination of all glenohumeral structures, the articular-sided supraspinatus tear is debrided with a 5-mm full-radius shaver (DePuy Mitek). The extent of the tear can be estimated based on the size of a shaver blade (the width of the articular side of the supraspinatus is estimated by comparing it with the known width of a 5-mm shaver) or with an arthroscopic ruler. Then, the surgeon inserts Prolene suture (Ethicon, Somerville, NJ) from an 18-gauge spinal needle stretching from the subacromial zone to the joint, ensuring that it passes from the supraspinatus articular tear area, and the Prolene suture proceeds inside the joi...

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“…Increasingly, the need for direct repair was recognized in the literature, because of a high probability of progression into complete tears of up to 35% after debridement alone [5]. This seems to be true at least for tears involving more than 50% of the tendons's thickness.…”

Section: Introductionmentioning

confidence: 99%

“…Arthroscopic debridement with or without subacromial decompression [1] of articular surface partial lesions often did not produce satisfying and stable results over time [5]. Increasingly, the need for direct repair was recognized in the literature, because of a high probability of progression into complete tears of up to 35% after debridement alone [5].…”

Section: Introductionmentioning

confidence: 99%

Double Band Double-Pulley Repair for Articular Surface Partial Tears of the Supraspinatus in Throwing Athletes: Improving the Transtendon Technique

Martínez¹,

Buess²,

Hernandez³

2012

OJO

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Disabled shoulders of throwing athletes typically present with extended undersurface partial tears of the rotator cuff, which include the posterior supraspinatus and the anterior infraspinatus tendon to a variable extent. We propose a modified transtendon repair technique to adequately treat this subset of patients. The repair includes two double-loaded anchors, at the anterior and the posterior end of the tear, respectively. With the help of an angulated penetrator we create a medial and a lateral band of sutures on top of the cuff, producing a broad contact in the tendon-to-bone interface. All the 9 so far operated patients were young men, 7 of them base-ball pitchers, and 5 active in competitive sports. The Constant Score rose from 72 points preoperatively to 99 points at 12 months follow-up. Three of the still active pitchers were able to return to their previous level in sports after one year. The improved footprint contact of our novel repair construct should allow for better healing and, therefore, a higher chance of return to competition.

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The Arthroscopic Management of Partial-Thickness Rotator Cuff Tears: A Systematic Review of the Literature

Cited by 156 publications

References 41 publications

Transtendon, Double-Row, Transosseous-Equivalent Arthroscopic Repair of Partial-Thickness, Articular-Surface Rotator Cuff Tears

Transtendon, Double-Row, Transosseous-Equivalent Arthroscopic Repair of Partial-Thickness, Articular-Surface Rotator Cuff Tears

Rotator Cerclage Technique for Partial Rotator Cuff Ruptures

Double Band Double-Pulley Repair for Articular Surface Partial Tears of the Supraspinatus in Throwing Athletes: Improving the Transtendon Technique

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