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Improved outcomes with arthroscopic repair of partial-thickness rotator cuff tears: a systematic review

Knee Surgery, Sports Traumatology, Arthroscopy volume 26, pages 113–124 (2018)Cite this article

Abstract

Purpose

The optimum treatment strategy for the surgical management of partial-thickness rotator cuff tears (PTRCT) is evolving. In this study, two research questions were sought to be answered: “Does the repair technique for PTRCTs involving >50% of the tendon thickness have an effect on structural and functional outcomes of arthroscopic repair?” and “Is there a difference in outcomes of arthroscopically treated articular- and bursal-sided PTRCTs?”.

Methods

A systematic review according to the PRISMA statement was conducted to identify all literature published reporting on outcomes of arthroscopic treatment of PTRCTs classified with the Ellman classification with minimum 2-year follow-up. Prospective randomized trials were eligible for quantitative synthesis. A total of 19 studies, published between 1999 and 2015, met the inclusion criteria of this systematic review. Two studies reporting outcomes of articular-sided PTRCTs with prospective randomized study design were included in quantitative synthesis calculations.

Results

Arthroscopic repair of PTRCTs >50% thickness results in significant pain relief and good to excellent functional outcomes. When in situ repair was compared with repair of the tendon after completion to full-thickness RCT, there were no significant differences in functional or structural outcomes or complication rates. The best treatment method for low-grade PTRCTs remains unclear.

Conclusions

The repair technique (in situ repair versus repair of the tendon after completion to full-thickness RCT) did not significantly affect the outcomes for arthroscopic repair of PTRCTs >50% thickness. The current literature contains evidence for inferior outcomes and higher failure rates after arthroscopic debridement of bursal-sided compared to articular-sided PTRCTs, and some evidence suggests that repair of lower-grade bursal-sided tears may be beneficial over debridement.

Level of evidence

IV.

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Fig. 1

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Acknowledgements

We would like to acknowledge Grant J. Dornan, MSc for his assistance with statistical analysis.

Authors contribution

JCK conceived the study and design, acquired and interpreted data, drafted the manuscript, has given final approval and agrees to be accountable for all aspects of the work. GB conceived the study and design, acquired and interpreted data, helped draft the manuscript, has given final approval and agrees to be accountable for all aspects of the work. GM acquired and interpreted data, helped draft the manuscript, has given final approval and agrees to be accountable for all aspects of the work. DST acquired and interpreted data, helped draft and revise the manuscript, has given final approval and agrees to be accountable for all aspects of the work. PJM conceived the study and design, revised it critically, has given final approval and agrees to be accountable for all aspects of the work.

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Affiliations

  1. Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 West Meadow Drive Suite 1000, Vail, CO, 81657, USA

    J. Christoph Katthagen, Gilbert Moatshe, Dimitri S. Tahal & Peter J. Millett

  2. Consorci Sanitari del Maresme, Hospital de Mataró, Barcelona, Spain

    Gabriella Bucci

  3. Department of Orthopaedic Surgery, Oslo University Hospital and University of Oslo, Oslo, Norway

    Gilbert Moatshe

  4. OSTRC, The Norwegian School of Sports Sciences, Oslo, Norway

    Gilbert Moatshe

  5. The Steadman Clinic, 181 West Meadow Drive Suite 400, Vail, CO, 81657, USA

    Peter J. Millett

  6. Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert- Schweitzer-Campus 1, 48149, Münster, Germany

    J. Christoph Katthagen

Authors
  1. J. Christoph Katthagen
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  2. Gabriella Bucci
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  5. Peter J. Millett
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Corresponding author

Correspondence to Peter J. Millett.

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Conflict of interest

Other than GM and PJM none of the other authors declare they have no conflict of interest.

Funding

This research study was not funded directly by any organization but was supported by Steadman Philippon Research Institute and their corporate sponsors.

Ethical approval

This was a systematic review of published literature, and and IRB approval was not required.

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Informed consent was not applicable to this study.

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Katthagen, J.C., Bucci, G., Moatshe, G. et al. Improved outcomes with arthroscopic repair of partial-thickness rotator cuff tears: a systematic review. Knee Surg Sports Traumatol Arthrosc 26, 113–124 (2018). https://doi.org/10.1007/s00167-017-4564-0

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Keywords

  • Partial-thickness
  • Rotator cuff tear
  • Debridement
  • Repair
  • Arthroscopy
  • Transtendon
  • Conversion to full-thickness