Management of Partial-Thickness Rotator Cuff Tears: Biologic and Surgical Interventions

Partial-thickness rotator cuff tears (PTRCTs) are a common source of shoulder pathology, both in the aging population and in younger overhead athletes. Advanced imaging modalities used currently have led to increases in recognition, diagnosis, and treatment of these tears. The anatomy, five-layer histology, and relationship to the Ellman classification of PTRCTs have been well studied, with recent interest in radiographic predictors, such as the critical shoulder angle and acromial index. Almost all PTRCTs should be managed nonsurgically initially. If nonsurgical management is unsuccessful, the surgical options are either arthroscopic débridement with or without acromioplasty if the tear thickness is less than 50%, or arthroscopic conversion repair or in situ repair if the tear thickness is greater than 50%. The biologic augmentation of PTRCTs is promising, with leukocyte-poor platelet-rich plasma having the most robust supporting data. Mesenchymal signaling cell biologics and the variety of scaffold onlay augments have been receiving increased attention in clinical practice but require more rigorous studies before widespread usage.