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Arthroscopic repair of Partial thickness cuff tears

May 2nd, 2007

Tears of the rotator cuff may not be full thickness. Partial tears are either intraarticular--on the inside surface of the cuff, and visualized from the inside of the shoulder joint-- or bursal-sided partial tears--not seen from the inside, but identified from the subacromial view.

Partial cuff tears may potentially be distinguished on an MRI, but can absolutely be diagnosed at the time of arthroscopic surgery. This is the primary reason that rotator cuff surgery should ideally include a diagnostic arthroscopic assessment.

Inraarticular partial tears are called PASTA lesions (partial articular sided tendon avulsions), and they can be caused by impingement from a bone spur or CA ligament, age-related degeneration, impingement on the glenoid rim from instability, or tension failure from throwing activities, for example.

Surgical treatment begins with arthroscopic debridement. 75-85% of debrided PASTA lesions get better when an outlet obstruction (bone spur) is treated with acromioplasty. If a near complete "partial" tear is felt to be at significant risk of becoming a full tear, repair may be indicated, but it's worth noting that most of the time this is not necessary. In light of the rehabilitative demands following a cuff repair, and the need for a sling for 6 weeks, I think it is attractive to debride PASTA lesions in most cases.

Over the past 5 years I have had to take only 5% of patients back to the OR at 4-6 months to fix a partial tear--which means scraping it off the bone and repairing it. In such cases results are very good over 95% of the time.

By contrast, bursal sided partial tears are easily fixed without having to disrupt the inside part of the tendon that is still attached.Sofor bursal-sided partial tears,I usually recommend repair. Postoperatively you will spend 6 weeks in a sling during which PT will help you keep your motion with passive exercisies. At 6 weeks active motion begins and you can start to drive. Strengthening begins at 10 weeks---but no golf or tennis for a full 4 months.

Related Photos:

Bursal side partial tear

Repaired bursal side partial tear

Bursal side of cuff in tact with PASTA lesion

PASTA lesion noted. This is an intraarticular partial tear

Related Videos:

1. bursal tear visualized
2. suture anchor is placed
3. Bursal side repair initiated with passage of spectrum device
4. Suture shuttled through partial tear prior to knot tying
5. Repaired bursal side partial tear
1. PASTA lesion debrided
2. PASTA lesion marked with PDS to facilitate assessment of the bursal side of the tendon
3. Assessment of the in tact bursal side of the cuff. This PASTA lesion was debrided only.