High-Grade Partial Thickness Rotator Cuff Tears
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

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.

LEARN MORE ABOUT AAOS

The Future of OrthoGuidelines

FIND OUT MORE

The OrthoGuidelines Process