Strong evidence supports the use of either conversion to full-thickness or transtendinous/in-situ repair in patients that failed conservative management with high-grade partial thickness rotator cuff tears.

Management of Rotator Cuff Injuries
Endorsed by: AANA, ASES, AOSSM, ASSET, APTA
Strong Evidence STRONG EVIDENCE
Rationale
There were two high quality study (Kim Y-S et al. 2015, and Shin et al. 2012) and two moderate quality studies (Castagna et al., Franceschi et al.).  The remainder of published studies either had too few subjects (<20) or were low quality level IV studies.  Kim Y-S et al. in a level II study noted no difference in either clinical outcomes or re-tear rates comparing transtendinous versus tear completion in Ellman III partial thickness rotator cuff tears.  Bursal side cuff tears had a higher re-tear rate with either technique.  Shin et al. in a level II study noted similar outcomes for the two groups but noted a significantly faster recovery with tear completion.  Retears were higher in the tear completion group but did not reach statistical significance. Castagna et al. looked at a total of 74 patients randomized to transtendinous versus tear completion.  There were no significant differences between the two groups.  Franceschi et al. in a level II study felt that outcomes and re-tear rates were comparable between transtendinous repair and tear completion.

Risks and Harms of Implementing this Recommendation
None.

Future Research
Additional high quality level one studies with longer follow-up would be useful to establish if the results of these techniques hold up with time. Larger studies might also establish risk of retear with differing techniques.
  1. Castagna, A, Borroni, M, Garofalo, R, Rose, Gd, Cesari, E, Padua, R, Conti, M, Gumina, S Deep partial rotator cuff tear: transtendon repair or tear completion and repair? A randomized clinical trial. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2015; 2: 460-3
  2. Franceschi, F., Papalia, R., Del Buono, A., Vasta, S., Costa, V., Maffulli, N., Denaro, V. Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial. International Orthopaedics 2013; 8: 1487-93
  3. Kim, Y. S., Lee, H. J., Bae, S. H., Jin, H., Song, H. S. Outcome Comparison Between in Situ Repair Versus Tear Completion Repair for Partial Thickness Rotator Cuff Tears. Arthroscopy 2015; 11: 2191-8
  4. Shin, S. J. A comparison of 2 repair techniques for partial-thickness articular-sided rotator cuff tears. Arthroscopy 2012; 1: 25-33