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Partial and Full-Thickness RCT: Modern Repair Techniques

  • Rotator Cuff Repair (M Tao and M Teusink, section editors)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this article is to review the recent literature concerning modern repair techniques related to partial- and full-thickness rotator cuff tears.

Recent Findings

The understanding of rotator cuff pathology and healing continues to evolve, beginning with emerging descriptions of the anatomic footprint and natural history of rotator cuff tears. Significant controversy remains in treatment indications for partial-thickness rotator cuff lesions as well as optimal surgical repair techniques for both partial- and full-thickness tears. Techniques such as margin convergence and reduction of the so-called “comma” tissue have improved the ability to anatomically reduce large and retracted tears. Repair strength and contact pressures are improved with double-row repairs and transosseus-equivalent techniques compared to traditional single-row repairs. Future work is directed towards obtaining reliable radiographic healing and demonstrating clinical superiority and cost-effectiveness of a single technique.

Summary

Much recent work regarding rotator cuff anatomy and pathology has been reported. Newer techniques improve repair strength. Despite these advances, significant questions remain concerning surgical indications and clinical outcomes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elb Surg. 2010;19(1):116–20. https://doi.org/10.1016/j.jse.2009.04.006.

  2. Mall NA, Kim HM, Keener JD, Steger-May K, Teefey SA, Middleton WD, et al. Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables. J Bone Joint Surg Am. 2010;92(16):2623–33. https://doi.org/10.2106/JBJS.I.00506.

  3. Safran O, Schroeder J, Bloom R, Weil Y, Milgrom C. Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger. Am J Sports Med. 2011;39(4):710–4. https://doi.org/10.1177/0363546510393944.

    Article  PubMed  Google Scholar 

  4. • Keener JD, Galatz LM, Teefey SA, Middleton WD, Steger-May K, Stobbs-Cucchi G, et al. A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears. J Bone Joint Surg Am. 2015;97(2):89–98. https://doi.org/10.2106/JBJS.N.00099. Keener and colleagues prospectively report on the long-term risks of rotator cuff enlargement and symptom progression associated with asymptomatic degenerative tears. Their study found a statistically significant increased risk of tear enlargement in full-thickness tears compared to partial thickness tears and controls. Furthermore, tear enlargement was significantly associated with development of symptoms and muscle degeneration/fatty infiltration.

  5. Maman E, Harris C, White L, Tomlinson G, Shashank M, Boynton E. Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. J Bone Joint Surg Am. 2009;91(8):1898–906. https://doi.org/10.2106/JBJS.G.01335.

    Article  PubMed  Google Scholar 

  6. Fucentese SF, von Roll AL, Pfirrmann CW, Gerber C, Jost B. Evolution of nonoperatively treated symptomatic isolated full-thickness supraspinatus tears. J Bone Joint Surg Am. 2012;94(9):801–8. https://doi.org/10.2106/JBJS.I.01286.

    Article  PubMed  Google Scholar 

  7. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86-A(2):219–24.

    Article  PubMed  Google Scholar 

  8. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005;87(6):1229–40. https://doi.org/10.2106/JBJS.D.02035.

    PubMed  Google Scholar 

  9. Rebuzzi E, Coletti N, Schiavetti S, Giusto F. Arthroscopic rotator cuff repair in patients older than 60 years. Arthroscopy. 2005;21(1):48–54. https://doi.org/10.1016/j.arthro.2004.09.019.

    Article  PubMed  Google Scholar 

  10. Jost B, Pfirrmann CW, Gerber C, Switzerland Z. Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2000;82(3):304–14. https://doi.org/10.2106/00004623-200003000-00002.

    Article  CAS  PubMed  Google Scholar 

  11. Miller BS, Downie BK, Kohen RB, Kijek T, Lesniak B, Jacobson JA, et al. When do rotator cuff repairs fail? Serial ultrasound examination after arthroscopic repair of large and massive rotator cuff tears. Am J Sports Med. 2011;39(10):2064–70. https://doi.org/10.1177/0363546511413372.

  12. Slabaugh MA, Nho SJ, Grumet RC, Wilson JB, Seroyer ST, Frank RM, et al. Does the literature confirm superior clinical results in radiographically healed rotator cuffs after rotator cuff repair? Arthroscopy. 2010;26(3):393–403. https://doi.org/10.1016/j.arthro.2009.07.023.

  13. Codman EA. The shoulder; rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Boston: Mass.: T. Todd company; 1934.

    Google Scholar 

  14. Curtis AS, Burbank KM, Tierney JJ, Scheller AD, Curran AR. The insertional footprint of the rotator cuff: an anatomic study. Arthroscopy. 2006;22(6):609. e1. https://doi.org/10.1016/j.arthro.2006.04.001.

    Article  PubMed  Google Scholar 

  15. Minagawa H, Itoi E, Konno N, Kido T, Sano A, Urayama M, et al. Humeral attachment of the supraspinatus and infraspinatus tendons: an anatomic study. Arthroscopy. 1998;14(3):302–6. https://doi.org/10.1016/S0749-8063(98)70147-1.

  16. •• Mochizuki T, Sugaya H, Uomizu M, Maeda K, Matsuki K, Sekiya I, et al. Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. J Bone Joint Surg Am. 2008;90(5):962–9. https://doi.org/10.2106/JBJS.G.00427. Mochizuki and colleagues present an anatomic cadaveric study in which the humeral footprint of the rotator cuff is described. Contrary to previously accepted anatomy, they describe the insertion of the infraspinatus as occupying the majority of the rotator cuff footprint on the greater tuberosity curving much further anteriorly as it extended laterally. They postulate that restoration of normal infraspinatus anatomy may be important for complete restoration of shoulder motion and overall function.

  17. Dugas JR, Campbell DA, Warren RF, Robie BH, Millett PJ. Anatomy and dimensions of rotator cuff insertions. J Shoulder Elb Surg. 2002;11(5):498–503. https://doi.org/10.1067/mse.2002.126208.

    Article  Google Scholar 

  18. Albritton MJ, Graham RD, Richards RS 2nd, Basamania CJ. An anatomic study of the effects on the suprascapular nerve due to retraction of the supraspinatus muscle after a rotator cuff tear. J Shoulder Elb Surg. 2003;12(5):497–500. https://doi.org/10.1016/S1058274603001824.

    Article  Google Scholar 

  19. Vad VB, Southern D, Warren RF, Altchek DW, Dines D. Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy. J Shoulder Elb Surg. 2003;12(4):333–6. https://doi.org/10.1016/mse.2003.S1058274603000405.

    Article  Google Scholar 

  20. Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: a radiological study of the critical shoulder angle. Bone Joint J. 2013;95-B(7):935–41. https://doi.org/10.1302/0301-620X.95B7.31028.

    Article  CAS  PubMed  Google Scholar 

  21. Hughes RE, Bryant CR, Hall JM, Wening J, Huston LJ, Kuhn JE, et al. Glenoid inclination is associated with full-thickness rotator cuff tears. Clin Orthop Relat Res. 2003;407:86–91. https://doi.org/10.1097/00003086-200302000-00016.

  22. Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(4):800–5. https://doi.org/10.2106/JBJS.D.03042.

    PubMed  Google Scholar 

  23. Wong AS, Gallo L, Kuhn JE, Carpenter JE, Hughes RE. The effect of glenoid inclination on superior humeral head migration. J Shoulder Elb Surg. 2003;12(4):360–4. https://doi.org/10.1016/mse.2003.S1058274603000260.

    Article  Google Scholar 

  24. Gerber C, Snedeker JG, Baumgartner D, Viehofer AF. Supraspinatus tendon load during abduction is dependent on the size of the critical shoulder angle: a biomechanical analysis. J Orthop Res. 2014;32(7):952–7. https://doi.org/10.1002/jor.22621.

    Article  PubMed  Google Scholar 

  25. Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S. Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elb Surg. 2014;23(4):536–41. https://doi.org/10.1016/j.jse.2013.11.008.

    Article  Google Scholar 

  26. Blonna D, Giani A, Bellato E, Mattei L, Calo M, Rossi R, et al. Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoulder. J Shoulder Elb Surg. 2016;25(8):1328–36. https://doi.org/10.1016/j.jse.2015.11.059.

    Article  Google Scholar 

  27. Cherchi L, Ciornohac JF, Godet J, Clavert P, Kempf JF. Critical shoulder angle: measurement reproducibility and correlation with rotator cuff tendon tears. Orthop Traumatol Surg Res. 2016;102(5):559–62. https://doi.org/10.1016/j.otsr.2016.03.017.

    Article  CAS  PubMed  Google Scholar 

  28. Spiegl UJ, Horan MP, Smith SW, Ho CP, Millett PJ. The critical shoulder angle is associated with rotator cuff tears and shoulder osteoarthritis and is better assessed with radiographs over MRI. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2244–51. https://doi.org/10.1007/s00167-015-3587-7.

    Article  PubMed  Google Scholar 

  29. Garcia GH, Liu JN, Degen RM, Johnson CC, Wong A, Dines DM, et al. Higher critical shoulder angle increases the risk of retear after rotator cuff repair. J Shoulder Elb Surg. 2017;26(2):241–5. https://doi.org/10.1016/j.jse.2016.07.009.

  30. Kirsch JM, Nathani A, Robbins CB, Gagnier JJ, Bedi A, Miller BS. Is there an association between the "critical shoulder angle" and clinical outcome after rotator cuff repair? Orthop J Sports Med. 2017;5(4):2325967117702126. https://doi.org/10.1177/2325967117702126.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lee M, Chen JY, Liow MHL, Chong HC, Chang P, Lie D. Critical shoulder angle and acromial index do not influence 24-month functional outcome after arthroscopic rotator cuff repair. Am J Sports Med. 2017;45(13):2989–94. https://doi.org/10.1177/0363546517717947.

    Article  PubMed  Google Scholar 

  32. Katthagen JC, Marchetti DC, Tahal DS, Turnbull TL, Millett PJ. The effects of arthroscopic lateral Acromioplasty on the critical shoulder angle and the anterolateral deltoid origin: an anatomic cadaveric study. Arthroscopy. 2016;32(4):569–75. https://doi.org/10.1016/j.arthro.2015.12.019.

    Article  PubMed  Google Scholar 

  33. Marchetti DC, Katthagen JC, Mikula JD, Montgomery SR, Tahal DS, Dahl KD, et al. Impact of arthroscopic lateral Acromioplasty on the mechanical and structural integrity of the lateral deltoid origin: a cadaveric study. Arthroscopy. 2017;33(3):511–7. https://doi.org/10.1016/j.arthro.2016.08.015.

  34. MacDonald P, McRae S, Leiter J, Mascarenhas R, Lapner P. Arthroscopic rotator cuff repair with and without acromioplasty in the treatment of full-thickness rotator cuff tears: a multicenter, randomized controlled trial. J Bone Joint Surg Am. 2011;93(21):1953–60. https://doi.org/10.2106/JBJS.K.00488.

    Article  PubMed  Google Scholar 

  35. Abrams GD, Gupta AK, Hussey KE, Tetteh ES, Karas V, Bach BR Jr, et al. Arthroscopic repair of full-thickness rotator cuff tears with and without Acromioplasty: randomized prospective trial with 2-year follow-up. Am J Sports Med. 2014;42(6):1296–303. https://doi.org/10.1177/0363546514529091.

  36. Shin SJ, Oh JH, Chung SW, Song MH. The efficacy of acromioplasty in the arthroscopic repair of small- to medium-sized rotator cuff tears without acromial spur: prospective comparative study. Arthroscopy. 2012;28(5):628–35. https://doi.org/10.1016/j.arthro.2011.10.016.

    Article  PubMed  Google Scholar 

  37. Fukuda H. Partial-thickness rotator cuff tears: a modern view on Codman's classic. J Shoulder Elb Surg. 2000;9(2):163–8. https://doi.org/10.1067/mse.2000.101959.

    Article  CAS  Google Scholar 

  38. Connor PM, Banks DM, Tyson AB, Coumas JS, D'Alessandro DF. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. Am J Sports Med. 2003;31(5):724–7. https://doi.org/10.1177/03635465030310051501.

    Article  PubMed  Google Scholar 

  39. Lo IK, Burkhart SS. Transtendon arthroscopic repair of partial-thickness, articular surface tears of the rotator cuff. Arthroscopy. 2004;20(2):214–20. https://doi.org/10.1016/j.arthro.2003.11.042.

    Article  PubMed  Google Scholar 

  40. Fukuda H, Hamada K, Nakajima T, Tomonaga A. Pathology and pathogenesis of the intratendinous tearing of the rotator cuff viewed from en bloc histologic sections. Clin Orthop Relat Res. 1994;304:60–7.

    Google Scholar 

  41. Hyvonen P, Lohi S, Jalovaara P. Open acromioplasty does not prevent the progression of an impingement syndrome to a tear. Nine-year follow-up of 96 cases. J Bone Joint Surg Br. 1998;80(5):813–6. https://doi.org/10.1302/0301-620X.80B5.8533.

    Article  CAS  PubMed  Google Scholar 

  42. Cordasco FA, Backer M, Craig EV, Klein D, Warren RF. The partial-thickness rotator cuff tear: is acromioplasty without repair sufficient? Am J Sports Med. 2002;30(2):257–60. https://doi.org/10.1177/03635465020300021801.

    Article  PubMed  Google Scholar 

  43. Kartus J, Kartus C, Rostgard-Christensen L, Sernert N, Read J, Perko M. Long-term clinical and ultrasound evaluation after arthroscopic acromioplasty in patients with partial rotator cuff tears. Arthroscopy. 2006;22(1):44–9. https://doi.org/10.1016/j.arthro.2005.07.027.

    Article  PubMed  Google Scholar 

  44. Strauss EJ, Salata MJ, Kercher J, Barker JU, McGill K, Bach BR Jr, et al. Multimedia article. The arthroscopic management of partial-thickness rotator cuff tears: a systematic review of the literature. Arthroscopy. 2011;27(4):568–80. https://doi.org/10.1016/j.arthro.2010.09.019.

  45. Liem D, Alci S, Dedy N, Steinbeck J, Marquardt B, Mollenhoff G. Clinical and structural results of partial supraspinatus tears treated by subacromial decompression without repair. Knee Surg Sports Traumatol Arthrosc. 2008;16(10):967–72. https://doi.org/10.1007/s00167-008-0580-4.

    Article  PubMed  Google Scholar 

  46. Xiao J, Cui G. Clinical and structural results of arthroscopic repair of bursal-side partial-thickness rotator cuff tears. J Shoulder Elb Surg. 2015;24(2):e41–6. https://doi.org/10.1016/j.jse.2014.07.008.

    Article  Google Scholar 

  47. Iyengar JJ, Porat S, Burnett KR, Marrero-Perez L, Hernandez VH, Nottage WM. Magnetic resonance imaging tendon integrity assessment after arthroscopic partial-thickness rotator cuff repair. Arthroscopy. 2011;27(3):306–13. https://doi.org/10.1016/j.arthro.2010.08.017.

    Article  PubMed  Google Scholar 

  48. Kamath G, Galatz LM, Keener JD, Teefey S, Middleton W, Yamaguchi K. Tendon integrity and functional outcome after arthroscopic repair of high-grade partial-thickness supraspinatus tears. J Bone Joint Surg Am. 2009;91(5):1055–62. https://doi.org/10.2106/JBJS.G.00118.

    Article  PubMed  Google Scholar 

  49. Kim SJ, Kim SH, Lim SH, Chun YM. Use of magnetic resonance arthrography to compare clinical features and structural integrity after arthroscopic repair of bursal versus articular side partial-thickness rotator cuff tears. Am J Sports Med. 2013;41(9):2041–7. https://doi.org/10.1177/0363546513496214.

    Article  PubMed  Google Scholar 

  50. Kim KC, Shin HD, Cha SM, Park JY. Repair integrity and functional outcome after arthroscopic conversion to a full-thickness rotator cuff tear: articular- versus bursal-side partial tears. Am J Sports Med. 2014;42(2):451–6. https://doi.org/10.1177/0363546513512770.

    Article  PubMed  Google Scholar 

  51. Shin SJ. A comparison of 2 repair techniques for partial-thickness articular-sided rotator cuff tears. Arthroscopy. 2012;28(1):25–33. https://doi.org/10.1016/j.arthro.2011.07.005.

    Article  PubMed  Google Scholar 

  52. Castagna A, Delle Rose G, Conti M, Snyder SJ, Borroni M, Garofalo R. Predictive factors of subtle residual shoulder symptoms after transtendinous arthroscopic cuff repair: a clinical study. Am J Sports Med. 2009;37(1):103–8. https://doi.org/10.1177/0363546508324178.

    Article  PubMed  Google Scholar 

  53. Huberty DP, Schoolfield JD, Brady PC, Vadala AP, Arrigoni P, Burkhart SS. Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy. 2009;25(8):880–90. https://doi.org/10.1016/j.arthro.2009.01.018.

    Article  PubMed  Google Scholar 

  54. Brockmeier SF, Dodson CC, Gamradt SC, Coleman SH, Altchek DW. Arthroscopic intratendinous repair of the delaminated partial-thickness rotator cuff tear in overhead athletes. Arthroscopy. 2008;24(8):961–5. https://doi.org/10.1016/j.arthro.2007.08.016.

    Article  PubMed  Google Scholar 

  55. Spencer EE Jr. Partial-thickness articular surface rotator cuff tears: an all-inside repair technique. Clin Orthop Relat Res. 2010;468(6):1514–20. https://doi.org/10.1007/s11999-009-1215-x.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Gonzalez-Lomas G, Kippe MA, Brown GD, Gardner TR, Ding A, Levine WN, et al. In situ transtendon repair outperforms tear completion and repair for partial articular-sided supraspinatus tendon tears. J Shoulder Elb Surg. 2008;17(5):722–8. https://doi.org/10.1016/j.jse.2008.01.148.

  57. Peters KS, Lam PH, Murrell GA. Repair of partial-thickness rotator cuff tears: a biomechanical analysis of footprint contact pressure and strength in an ovine model. Arthroscopy. 2010;26(7):877–84. https://doi.org/10.1016/j.arthro.2010.04.007.

    Article  PubMed  Google Scholar 

  58. Castagna A, Borroni M, Garofalo R, Rose GD, Cesari E, Padua R, et al. Deep partial rotator cuff tear: transtendon repair or tear completion and repair? A randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2015;23(2):460–3. https://doi.org/10.1007/s00167-013-2536-6.

  59. Franceschi F, Papalia R, Del Buono A, Vasta S, Costa V, Maffulli N, et al. Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial. Int Orthop. 2013;37(8):1487–93. https://doi.org/10.1007/s00264-013-1882-9.

  60. Stuart KD, Karzel RP, Ganjianpour M, Snyder SJ. Long-term outcome for arthroscopic repair of partial articular-sided supraspinatus tendon avulsion. Arthroscopy. 2013;29(5):818–23. https://doi.org/10.1016/j.arthro.2013.02.004.

    Article  PubMed  Google Scholar 

  61. Liem D, Bartl C, Lichtenberg S, Magosch P, Habermeyer P. Clinical outcome and tendon integrity of arthroscopic versus mini-open supraspinatus tendon repair: a magnetic resonance imaging-controlled matched-pair analysis. Arthroscopy. 2007;23(5):514–21. https://doi.org/10.1016/j.arthro.2006.12.028.

    Article  PubMed  Google Scholar 

  62. Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL. Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elb Surg. 2006;15(3):290–9. https://doi.org/10.1016/j.jse.2005.09.017.

    Article  Google Scholar 

  63. Nho SJ, Shindle MK, Sherman SL, Freedman KB, Lyman S, MacGillivray JD. Systematic review of arthroscopic rotator cuff repair and mini-open rotator cuff repair. J Bone Joint Surg Am. 2007;89(Suppl 3):127–36. https://doi.org/10.2106/JBJS.G.00583.

    PubMed  Google Scholar 

  64. Lindley K, Jones GL. Outcomes of arthroscopic versus open rotator cuff repair: a systematic review of the literature. Am J Orthop (Belle Mead NJ). 2010;39(12):592–600.

    Google Scholar 

  65. Carr A, Cooper C, Campbell MK, Rees J, Moser J, Beard DJ, et al. Effectiveness of open and arthroscopic rotator cuff repair (UKUFF): a randomised controlled trial. Bone Joint J. 2017;99-B(1):107–15. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0424.R1.

  66. Burkhart SS, Athanasiou KA, Wirth MA. Margin convergence: a method of reducing strain in massive rotator cuff tears. Arthroscopy. 1996;12(3):335–8. https://doi.org/10.1016/S0749-8063(96)90070-5.

    Article  CAS  PubMed  Google Scholar 

  67. Mazzocca AD, Bollier M, Fehsenfeld D, Romeo A, Stephens K, Solovyoya O, et al. Biomechanical evaluation of margin convergence. Arthroscopy. 2011;27(3):330–8. https://doi.org/10.1016/j.arthro.2010.09.003.

  68. Kim SJ, Lee IS, Kim SH, Lee WY, Chun YM. Arthroscopic partial repair of irreparable large to massive rotator cuff tears. Arthroscopy. 2012;28(6):761–8. https://doi.org/10.1016/j.arthro.2011.11.018.

    Article  PubMed  Google Scholar 

  69. Nguyen ML, Quigley RJ, Galle SE, McGarry MH, Jun BJ, Gupta R, et al. Margin convergence anchorage to bone for reconstruction of the anterior attachment of the rotator cable. Arthroscopy. 2012;28(9):1237–45. https://doi.org/10.1016/j.arthro.2012.02.016.

  70. Tauro JC. Arthroscopic "interval slide" in the repair of large rotator cuff tears. Arthroscopy. 1999;15(5):527–30. https://doi.org/10.1053/ar.1999.v15.0150521.

    Article  CAS  PubMed  Google Scholar 

  71. Lo IK, Burkhart SS. Arthroscopic repair of massive, contracted, immobile rotator cuff tears using single and double interval slides: technique and preliminary results. Arthroscopy. 2004;20(1):22–33. https://doi.org/10.1016/j.arthro.2003.11.013.

    Article  PubMed  Google Scholar 

  72. • Kim SJ, Kim SH, Lee SK, Seo JW, Chun YM. Arthroscopic repair of massive contracted rotator cuff tears: aggressive release with anterior and posterior interval slides do not improve cuff healing and integrity. J Bone Joint Surg Am. 2013;95(16):1482–8. https://doi.org/10.2106/JBJS.L.01193. Kim and colleagues report their results comparing massive contracted rotator cuff tears treated with either complete repair with posterior interval slide versus partial repair without posterior interval slide. At 2 years following index operation, they showed no difference in clinical outcomes between the two techniques. Additionally, the group that underwent complete repair with aggressive interval slide showed a significantly higher re-tear rate on follow-up MR arthrogram.

    Article  PubMed  Google Scholar 

  73. Kim DH, Elattrache NS, Tibone JE, Jun BJ, DeLaMora SN, Kvitne RS, et al. Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med. 2006;34(3):407–14. https://doi.org/10.1177/0363546505281238.

    Article  CAS  PubMed  Google Scholar 

  74. Duquin TR, Buyea C, Bisson LJ. Which method of rotator cuff repair leads to the highest rate of structural healing? A systematic review. Am J Sports Med. 2010;38(4):835–41. https://doi.org/10.1177/0363546509359679.

    Article  PubMed  Google Scholar 

  75. Nho SJ, Slabaugh MA, Seroyer ST, Grumet RC, Wilson JB, Verma NN, et al. Does the literature support double-row suture anchor fixation for arthroscopic rotator cuff repair? A systematic review comparing double-row and single-row suture anchor configuration. Arthroscopy. 2009;25(11):1319–28. https://doi.org/10.1016/j.arthro.2009.02.005.

  76. • Park MC, Elattrache NS, Ahmad CS, Tibone JE. “Transosseous-equivalent” rotator cuff repair technique. Arthroscopy. 2006;22(12):1360 e1-5–1360.e5. https://doi.org/10.1016/j.arthro.2006.07.017. Park and colleagues describe the “trans-osseous equivalent” (TOE) technique (suture bridge) for rotator cuff repair. This technique improves tendon-bone surface contact area compared to single row repairs by the additional of a knotless lateral row. Additionally, it has higher ultimate load to failure compared to traditional double-row constructs.

  77. Cole BJ, ElAttrache NS, Anbari A. Arthroscopic rotator cuff repairs: an anatomic and biomechanical rationale for different suture-anchor repair configurations. Arthroscopy. 2007;23(6):662–9. https://doi.org/10.1016/j.arthro.2007.02.018.

    Article  PubMed  Google Scholar 

  78. Mihata T, Fukuhara T, Jun BJ, Watanabe C, Kinoshita M. Effect of shoulder abduction angle on biomechanical properties of the repaired rotator cuff tendons with 3 types of double-row technique. Am J Sports Med. 2011;39(3):551–6. https://doi.org/10.1177/0363546510388152.

    Article  PubMed  Google Scholar 

  79. Park MC, Tibone JE, ElAttrache NS, Ahmad CS, Jun BJ, Lee TQ. Part II: biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elb Surg. 2007;16(4):469–76. https://doi.org/10.1016/j.jse.2006.09.011.

    Article  Google Scholar 

  80. • Mall NA, Lee AS, Chahal J, Van Thiel GS, Romeo AA, Verma NN, et al. Transosseous-equivalent rotator cuff repair: a systematic review on the biomechanical importance of tying the medial row. Arthroscopy. 2013;29(2):377–86. https://doi.org/10.1016/j.arthro.2012.11.008. Mall and colleagues report a biomechanical study comparing trans-osseous equivalent repairs with medial row tying versus complete knotless repair. In their study, they demonstrate the importance of tying the medial row, showing greater hysteresis, less gap formation, and higher ultimate load to failure compared to complete knotless repairs.

  81. • Mihata T, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, Fujiwara K, et al. Functional and structural outcomes of single-row versus double-row versus combined double-row and suture-bridge repair for rotator cuff tears. Am J Sports Med. 2011;39(10):2091–8. https://doi.org/10.1177/0363546511415660. Mihata and colleagues reported some of the first clinical outcomes data comparing single-row, double-row, and trans-osseous equivalent rotator cuff repairs. Although the data is retrospective in nature, they showed lower re-tear rates and higher functional outcome scores in the TOE group for large and massive tears.

  82. Barth JR, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy. 2006;22(10):1076–84. https://doi.org/10.1016/j.arthro.2006.05.005.

    Article  PubMed  Google Scholar 

  83. Walch G, Nove-Josserand L, Levigne C, Renaud E. Tears of the supraspinatus tendon associated with “hidden” lesions of the rotator interval. J Shoulder Elb Surg. 1994;3(6):353–60. https://doi.org/10.1016/S1058-2746(09)80020-7.

    Article  CAS  Google Scholar 

  84. • Lo IK, Burkhart SS. The comma sign: an arthroscopic guide to the torn subscapularis tendon. Arthroscopy. 2003;19(3):334–7. https://doi.org/10.1053/jars.2003.50080. Lo and Burkhart describe the “comma sign” to aid in the recognition and reduction of subscapularis tendon tears. Composed of the superior glenohumeral ligament and coracohumeral ligament, they propose that reduction of this tissue to the remnant subscapularis has been shown to recreate the intraarticular aspect of the torn subscapularis tendon while concurrently reductng the leading edge of the supraspinatus tendon.

    Article  PubMed  Google Scholar 

  85. Dilisio MF, Neyton L. Comma sign-directed repair of anterosuperior rotator cuff tears. Arthrosc Tech 2014;3(6):e695–e698. doi:https://doi.org/10.1016/j.eats.2014.09.001.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Ide J, Tokiyoshi A, Hirose J, Mizuta H. Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Joint Surg Am. 2007;89(11):2378–88. https://doi.org/10.2106/JBJS.G.00082.

    PubMed  Google Scholar 

  87. Adams CR, Schoolfield JD, Burkhart SS. The results of arthroscopic subscapularis tendon repairs. Arthroscopy. 2008;24(12):1381–9. https://doi.org/10.1016/j.arthro.2008.08.004.

    Article  PubMed  Google Scholar 

  88. Bartl C, Salzmann GM, Seppel G, Eichhorn S, Holzapfel K, Wortler K, et al. Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears. Am J Sports Med. 2011;39(6):1255–62. https://doi.org/10.1177/0363546510396317.

    Article  PubMed  Google Scholar 

  89. Bartl C, Senftl M, Eichhorn S, Holzapfel K, Imhoff A, Salzmann G. Combined tears of the subscapularis and supraspinatus tendon: clinical outcome, rotator cuff strength and structural integrity following open repair. Arch Orthop Trauma Surg. 2012;132(1):41–50. https://doi.org/10.1007/s00402-011-1400-8.

    Article  PubMed  Google Scholar 

  90. Bennett WF. Arthroscopic repair of isolated subscapularis tears: a prospective cohort with 2- to 4-year follow-up. Arthroscopy. 2003;19(2):131–43. https://doi.org/10.1053/jars.2003.50053.

    Article  PubMed  Google Scholar 

  91. Bennett WF. Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/instability. Arthroscopy. 2003;19(1):21–33. https://doi.org/10.1053/jars.2003.50023.

    Article  PubMed  Google Scholar 

  92. Denard PJ, Jiwani AZ, Ladermann A, Burkhart SS. Long-term outcome of a consecutive series of subscapularis tendon tears repaired arthroscopically. Arthroscopy. 2012;11(11):1587–91. https://doi.org/10.1016/j.arthro.2012.02.031.

    Article  Google Scholar 

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  1. Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Stanford University, 450 Broadway, M/C 6342, Redwood City, CA, 94063, USA

    Amit Nathani, Kevin Smith & Tim Wang

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  1. Amit Nathani
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This article is part of the Topical Collection on Rotator Cuff Repair

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Nathani, A., Smith, K. & Wang, T. Partial and Full-Thickness RCT: Modern Repair Techniques. Curr Rev Musculoskelet Med 11, 113–121 (2018). https://doi.org/10.1007/s12178-018-9465-4

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