0 Item(s)
High-Grade Partial-Thickness Rotator Cuff Tears: Repair In Situ Versus Tear Completion and Repair
Partial-thickness rotator cuff tears (RCTs) are common pathologic lesions with greater prevalence in older individuals. Factors thought to contribute to the development of partial-thickness RCTs include decreased vascularity, accumulation of microtrauma from intratendinous shear stress, and internal or external impingement. Partial-thickness RCTs are more than twice as likely to be articular sided than bursal sided and commonly occur just posterior to the biceps tendon at the insertion of the rotator cuff cable (Figure 1). Partial articular-sided supraspinatus tendon avulsions are commonly called PASTA lesions. In athletes with internal impingement, articular-sided tears occur more posteriorly, at the confluence of the supraspinatus and the infraspinatus at the anterior margin of the bare area. These tears commonly delaminate the infraspinatus tendon into two layers and are referred to as partial articular intratendinous (PAINT) lesions. In the Ellman classification of partial-thickness RCTs, tears are graded on the basis of the thickness (grade 1, <3 mm or <25%; grade 2, 3 to 6 mm or 25% to 50%; grade 3, >6 mm or >50%) and location of the tear (articular, bursal, intratendinous). Tear size greater than 50% carries a higher risk of tear progression, and surgical treatment is indicated in these patients if 3 to 6 months of nonsurgical treatment fails.