Repair of partial tears of the rotator cuff

Partial-thickness rotator cuff tears present partial disruption of tendon fibers with no communication between the subacromial bursa and the glenohumeral joint. The clinical presentation is surprisingly variable, ranging from mild discomfort to decreased throwing speed, chronic pain, and shoulder inability. The first approach to partial-thickness rotator cuff tears is usually conservative, but the hypovascularity of the critical zone and mechanical factors often result in poor spontaneous tendon healing. Surgical options include arthroscopic cuff "debridement" or "repair," performed arthroscopically or by open surgery, and subacromial decompression or debridement if necessary. No agreement has been reached on the best surgical management. However, repair is usually indicated if bursal-sided and articular tears involve more than 50% of tendon thickness; debridement is generally undertaken if <50% of the rotator cuff is torn. There is a need for randomized clinical trails formulating and testing guidelines of management and for further studies on imaging or intraoperative measures and methods to assess the thickness of the rotator cuff to inform management.