In the absence of reliable evidence, the work group is unable to define a preference for the choice of debridement versus repair of high-grade partial-thickness cuff tears that have failed physical therapy, however repair of high grade partial tears could improve outcomes.

Management of Rotator Cuff Injuries
The limited publications comparing debridement to partial tear repair of the rotator cuff all are excluded under the exclusion criteria for the Guidelines.  Only two retrospective, comparative studies exist, both of which are case series studies that have non-consecutive enrollment of patients and so were excluded.   Weber SC (Weber, 1999) published a low quality study comparing an early series of debrided patients outcomes to a later series of repaired partial rotator cuff tears and had superior clinical outcomes and lower reoperation rates with partial tear repair.  Ogilvie-Harris et al. (Ogilvie-Harris,1993) evaluated a similar non-consecutive group. The open repair group scored better for function, strength and overall score, but patient satisfaction was similar in the two groups. They recommend repair for active patients, and debridement for low activity patients.

Risks and Harms of Implementing this Recommendation
While, given the level of evidence, overtreatment of partial rotator cuff tears may occur, what data is available suggests that only minimal harm would be associated with implementing this recommendation.

Future Research
High strength comparative studies between debridement and partial tear repair may further clarify the utility of these two techniques in managing partial rotator cuff tears.
  1. (147) Ogilvie-Harris DJ, Botsford DJ, Hawker RW. Elderly patients with hip fractures: improved outcome with the use of care maps with high-quality medical and nursing protocols. J Orthop Trauma 1993;7(5):428-437.
  2. Weber, S. C., Kauffman, J. I., Parise, C., Weber, S. J., Katz, S. D. Platelet-rich fibrin matrix in the management of arthroscopic repair of the rotator cuff: a prospective, randomized, double-blinded study. American Journal of Sports Medicine 2013; 2: 263-70