Partial Thickness Rotator Cuff Tears: Current Concepts

Abstract

Partial thickness rotator cuff tears are a common cause of pain in the adult shoulder. Despite their high prevalence, the diagnosis and treatment of partial thickness rotator cuff tears remains controversial. While recent studies have helped to elucidate the anatomy and natural history of disease progression, the optimal treatment, both nonoperative and operative, is unclear. Although the advent of arthroscopy has improved the accuracy of the diagnosis of partial thickness rotator cuff tears, the number of surgical techniques used to repair these tears has also increased. While multiple repair techniques have been described, there is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair. Further research is required to determine the clinical indications for surgical and nonsurgical management, when formal rotator cuff repair is specifically indicated and when biologic adjunctive therapy may be utilized.

Figure 1

Illustration showing the two different insertional descriptions of the humeral insertions of the supraspinatus (SSP-I) and infraspinatus (ISP-I). (a) The generally accepted concept of the supraspinatus inserting into the highest impression and the infraspinatus inserting into the middle impression of the greater tuberosity (GT). (b) An alternative illustration, in which the insertion of the infraspinatus occupies the majority of the GT, covering both the middle and half of the highest impression of the GT. Also noted is the additional attachment of the supraspinatus to the most superior aspect of the lesser tuberosity (LT). HH = humeral head (adapted and reprinted from [6] with permission).

Figure 2

Transtendon repair of a partial thickness articular surface rotator cuff tear. (a) An 18-gauge needle is used to localize the trajectory of the proposed suture anchor. The suture anchor inserted transtendon into the medial aspect of the bone bed. (b) A suture passer is used to shuttle sutures through the intact portion of the rotator cuff. (c) Four suture limbs have been shuttled through the tendon, creating two mattress stitches. (d) The mattress stitches are tied in the subacromial space, reducing the tendon to the bone. (e) After tying all of the sutures, the arthroscope is placed back in the glenohumeral joint to visualize the repair and the reduction of the tendon to the bone (adapted and reprinted from [7] with permission from Elsevier).