Partial-Thickness Rotator Cuff Tears

Wolff, Andrew B.; Sethi, Paul M.; Sutton, Karen M.; Covey, Aaron S.; Magit, David P.; Medvecky, Michael J.

doi:10.5435/00124635-200612000-00003

Cited by 103 publications

(93 citation statements)

References 40 publications

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“…1 Tendon tears can start as localized regions of tissue damage that increase in size as continued mechanical loading further weakens the tissue. For example rotator cuff tears, a common and potentially serious type of tendon injury with a prevalence of up to 80% in elderly individuals, 2 have been reported to measurably enlarge in approximately 50% of cases after two years. 3 In the case that a smaller tear progresses to a large tear, surgical repair of a full rotator cuff tear remains one of the least successful orthopedic interventions, with tear recurrence in up to 94% of cases (as summarized by Ref.…”

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confidence: 99%

Exogenous collagen cross‐linking recovers tendon functional integrity in an experimental model of partial tear

Fessel

Wernli

et al. 2011

Journal Orthopaedic Research

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We investigated the hypothesis that exogenous collagen cross-linking can augment intact regions of tendon to mitigate mechanical propagation of partial tears. We first screened the low toxicity collagen cross-linkers genipin, methylglyoxal and ultra-violet (UV) light for their ability to augment tendon stiffness and failure load in rat tail tendon fascicles (RTTF). We then investigated crosslinking effects in load bearing equine superficial digital flexor tendons (SDFT). Data indicated that all three cross-linking agents augmented RTTF mechanical properties but reduced native viscoelasticity. In contrast to effects observed in fascicles, methylglyoxal treatment of SDFT detrimentally affected tendon mechanical integrity, and in the case of UV did not alter tendon mechanics. As in the RTTF experiments, genipin cross-linking of SDFT resulted in increased stiffness, higher failure loads and reduced viscoelasticity. Based on this result we assessed the efficacy of genipin in arresting tendon tear propagation in cyclic loading to failure. Genipin cross-linking secondary to a mid-substance biopsy-punch significantly reduced tissue strains, increased elastic modulus and increased resistance to fatigue failure. We conclude that genipin cross-linking of injured tendons holds potential for arresting tendon tear progression, and that implications of the treatment on matrix remodeling in living tendons should now be investigated. ß

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confidence: 99%

Exogenous collagen cross‐linking recovers tendon functional integrity in an experimental model of partial tear

Fessel

Wernli

et al. 2011

Journal Orthopaedic Research

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“…When tied down, the bursal portion of the cuff will be overtightened by an amount equal to the degree of retraction of the articular layer. This overtightening might be the cause of the stiffness that has been reported after these repairs [9,28]. Therefore a technique was developed that attempts to repair just the PASTA lesion without passing suture through the bursal layer of the cuff, thereby performing the repair all inside the glenohumeral joint [23].…”

Section: Discussionmentioning

confidence: 99%

“…Although these techniques do not involve completing the tear, they do involve tying suture on the bursal side of the rotator cuff and potentially overtightening the bursal layer of the cuff. Some authors have reported increased stiffness with these transtendinous repair techniques [9,23,28]. Therefore, a repair technique that just addresses the abnormality by repairing the articular-side tear only and does not tie down the bursal side of the cuff has been developed.…”

Section: Introductionmentioning

confidence: 99%

Partial-thickness Articular Surface Rotator Cuff Tears: An All-inside Repair Technique

Spencer

2010

Clinical Orthopaedics &Amp; Related Research

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Background Treatment of partial-thickness articular surface rotator cuff tears varies from simple débridement with or without an acromioplasty to various repair techniques. These repair techniques have included in situ transtendinous methods, as well as completion of the tear and repairing the full-thickness defect. The transtendinous techniques can be associated with stiffness and completing the tear takes down normal intact tissue. Therefore, a technique was developed that repairs the articular-side partial-thickness rotator cuff tears with an all-inside approach that does not violate the intact bursal tissue and does not complete the tear. Questions/purposes To compare the preoperative and postoperative Penn shoulder scores (PSS) associated with an in situ all-inside repair technique and the effects of such a repair on postoperative stiffness. Methods Twenty patients with partial-thickness articular rotator cuff tears greater than 50% of the width of the tendon repaired with an all-inside repair technique were retrospectively reviewed. Two of the patients were high school athletes and the rest self-described as recreational athletes. The minimum followup was 16 months (average, 29 months; range, 16-41 months). A validated outcome measure (PSS) was used to assess clinical outcome, and postoperative ROM was measured. Results The average PSS score improved from 74 (range, 56-84) to 92 (range, 86-99).

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“…3 Only recently, however, has the literature recognized articular-sided PTRCTs as distinct from bursal-sided PTRCTs in both mechanism and potential treatment modalities. 4 Articular surface PTRCTs are reported 2 to 3 times more commonly than bursal-only PTRCTs in the literature. 5 More partial-thickness tears in older patients are articular-sided supraspinatus tears than bursal sided, and the most commonly reported tear in younger overhead throwing athletes is on the articular side at the supraspinatus-infraspinatus junction.…”

mentioning

confidence: 99%

“…5 More partial-thickness tears in older patients are articular-sided supraspinatus tears than bursal sided, and the most commonly reported tear in younger overhead throwing athletes is on the articular side at the supraspinatus-infraspinatus junction. 4 It has been noted that there is a relative hypovascularity of the articular surface of the supraspinatus tendon compared with the bursal surface, which may contribute to the higher incidence of degenerative tearing of the articular surface at the insertion of the supraspinatus. 6 The articular and bursal sides of the supraspinatus differ in their histology as well: The bursal side of the cuff contains mainly tendinous bundles, giving it a greater tensile strength, whereas the articular side is a more complex mixture of ligament, capsule, and tendon.…”

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confidence: 99%

A Novel Arthroscopic Inside-Out Repair Technique for PASTA Lesions

Caldwell

Elfar

2014

Arthroscopy Techniques

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There is no current consensus in the literature on the optimal technique for surgical treatment of partial articular-sided supraspinatus tendon avulsion (PASTA) lesions, although most techniques described to date require takedown of the partially torn tendon or passage of an anchor through the already damaged tendon. We describe a novel inside-out repair technique for partial articular surface supraspinatus tears that does not require further disruption of the partially torn tendon by passage of an anchor.P artial-thickness rotator cuff tears (PTRCTs) have long been recognized as distinct from full-thickness rotator cuff tears. They have been noted in as many as 26% of asymptomatic patients aged 40 to 60 years 1 but can present with a wide spectrum of symptoms including a higher level of reported pain than fullthickness tears. 2 They have also been noted to occur in the younger population, particularly overhead throwing athletes. 3 Only recently, however, has the literature recognized articular-sided PTRCTs as distinct from bursal-sided PTRCTs in both mechanism and potential treatment modalities. 4 Articular surface PTRCTs are reported 2 to 3 times more commonly than bursal-only PTRCTs in the literature. 5 More partial-thickness tears in older patients are articular-sided supraspinatus tears than bursal sided, and the most commonly reported tear in younger overhead throwing athletes is on the articular side at the supraspinatus-infraspinatus junction. 4 It has been noted that there is a relative hypovascularity of the articular surface of the supraspinatus tendon compared with the bursal surface, which may contribute to the higher incidence of degenerative tearing of the articular surface at the insertion of the supraspinatus. 6 The articular and bursal sides of the supraspinatus differ in their histology as well: The bursal side of the cuff contains mainly tendinous bundles, giving it a greater tensile strength, whereas the articular side is a more complex mixture of ligament, capsule, and tendon. 7 Although the initial treatment for most articular-sided PTRCTs is nonoperative and symptomatically oriented, the natural history of these lesions remains unclear. Cadaveric studies have shown an increase in strain on the remaining intact supraspinatus tendon during abduction when a 33% thickness partial articular-sided supraspinatus avulsion (PASTA) lesion is created, 8 and a serial arthrography study found that 27% of articular-sided tears progressed to full-thickness tears over a 1-year period whereas only 10% appeared to heal completely. 9 This finding suggests that even when nonoperative treatment is successful in resolving symptoms, it is unlikely that this represents healing of the tear. Failure of conservative management is considered an indication for surgical intervention.There is no consensus in the literature regarding the ideal technique for treatment of PASTA lesions, although many techniques have been described, including simple debridement, tear completion and complete repair, and a variety ...

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Partial-Thickness Rotator Cuff Tears

Cited by 103 publications

References 40 publications

Exogenous collagen cross‐linking recovers tendon functional integrity in an experimental model of partial tear

Exogenous collagen cross‐linking recovers tendon functional integrity in an experimental model of partial tear

Partial-thickness Articular Surface Rotator Cuff Tears: An All-inside Repair Technique

A Novel Arthroscopic Inside-Out Repair Technique for PASTA Lesions

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