Partial Rotator Cuff Tears: a review of the literature

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:30-34 | Stefania Kokkineli, Emmanouil Brilakis, Emmanouil Antonogiannakis

Author: Stefania Kokkineli [1], Emmanouil Brilakis [1], Emmanouil Antonogiannakis [1]

[1] Department of Orthopaedic, HYGEIA Hospital. MD. Erythrou Stavrou 4, Marousi 15123

Address of Correspondence
Dr. Stefania Kokkineli,
Department of Orthopaedic, HYGEIA Hospital. Athens, Greece
Address: Erythrou Stavrou 4, Marousi 15123. Greece


Partial- thickness rotator cuff tears are the most common cause of shoulder pain in adults and have been classified into subtypes according to location and depth. The frequency rate and tear size progression increase with age, tobacco use and medical comorbidities. Partial tears are divided into tears of acute, chronic or acute-on-chronic onset. Surgical treatment is indicated in symptomatic patients with persistent pain after failed conservative treatment of at least 3 months, mainly with tears that exceed 50% of the tendon thickness. Arthroscopic repair techniques include in situ and tear completion repair. Authors’ preferred technique for in situ repair is described followed by the postoperative rehabilitation protocol. The surgical techniques described have various advantages and disadvantages with regard to intra- operative complications, clinical outcomes, recovery time and re-tear rates which make it difficult to decide on which technique to use. The option is a matter of surgical indications, philosophy and skills.
Keywords: Partial-thickness rotator cuff tears, transtendon repair, in-situ repair, shoulder, arthroscopy


1. Kim, Y., S., Kim, S., E., Bae, S., H., Lee, H., J., Jee, W., H., Park, C. K. Tear progression of symptomatic full-thickness and partial-thickness rotator cuff tears as measured by repeated MRI. Knee Surg Sports Arthrosc. 2016;25(7), 2073–2080. doi:10.1007/s00167-016-4388-3.
2. Liu, C., T., Ge, H. an, Hu, R., Huang, J., B., Cheng, Y. C., Wang, M., et al. Arthroscopic knotless single-row repair preserving full footprint versus tear completion repair for partial articular-sided rotator cuff tear. J Orthop Surg. 2018;26(2):230949901877089. doi:10.1177/2309499018770897.
3. Salem, H., Carter, A., Tjoumakaris, F., Freedman, K., B. Double-Row Repair Technique for Bursal-Sided Partial-Thickness Rotator Cuff Tears. Arthrosc Tech. 2018;7(3):e199–e203. doi:10.1016/j.eats.2017.08.068.
4. Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res. 1990;(254):64–74.
5. Fukuda, H. THE MANAGEMENT OF PARTIAL-THICKNESS TEARS OF THE ROTATOR CUFF. JBJS Br. 2013;85-B(1):3–11. doi:10.1302/0301-620x.85b1.13846.
6. Nathani, A., Smith, K., Wang, T. Partial and Full-Thickness RCT: Modern Repair Techniques. Curr Rev Musculoskelet Med. 2018;11(1):113–121. doi:10.1007/s12178-018-9465-4.
7. Vinanti, G., B., Rossato, A., Scrimieri, D., Petrera, M. Arthroscopic transtendon repair of partial articular-sided supraspinatus tendon avulsion. Knee Surg Sports Trauma Arthrosc. 2016;25(7):2151–2156. doi:10.1007/s00167-015-3953-5.
8. Ardeljan A, Palmer J, Drawbert H, Ardeljan A, Vakharia RM, Roche MW. Partial thickness rotator cuff tears: Patient demographics and surgical trends within a large insurance database. J Orthop. 2019;17:158‐161. doi:10.1016/j.jor.2019.08.027.
9. Lee CS, Davis SM, Doremus B, Kouk S, Stetson WB. Interobserver Agreement in the Classification of Partial-Thickness Rotator Cuff Tears Using the Snyder Classification System. Orthop J Sports Med. 2016;4(9):2325967116667058. doi:10.1177/2325967116667058.
10. Kanatli, U., Ayanoğlu, T., Aktaş, E., Ataoğlu, M. B., Özer, M., Çetinkaya, M. Grade of coracoacromial ligament degeneration as a predictive factor for impingement syndrome and type of partial rotator cuff tear. JSES. 2016;25(11), 1824–1828. doi:10.1016/j.jse.2016.02.026.
11. Jordan, R., W., Bentick, K., Saithna, A. Transtendinous Repair of Partial Articular Sided Supraspinatus Tears is associated with Higher Rates of Stiffness and Significantly Inferior Early Functional Scores than Tear Completion and Repair: A Systematic Review. Orthop Traumatol Surg. 2018;104(6):829-837. doi:10.1016/j.otsr.2018.06.007.
12. Liem, D., Gosheger, G., Vogler, T. PASTA-Läsionen – Debridement versus Naht. Der Orthopäde. 2016;45(2):125–129. doi:10.1007/s00132-015-3201-1.
13. Kim HJ, Kim JY, Kee YM, Rhee YG. Bursal-Sided Rotator Cuff Tears: Simple Versus Everted Type. Am J Sports Med. 2017;46(2):441–448. doi:10.1177/0363546517739577.
14. Habermeyer, P., Krieter, C., Tang, K., Lichtenberg, S., Magosch, P. A new arthroscopic classification of articular-sided supraspinatus footprint lesions: A prospective comparison with Snyder’s and Ellman’s classification. JSES. 2008;17(6):909–913. doi:10.1016/j.jse.2008.06.007.
15. Rahu, M., Kartus, J., T., Põldoja, E., Pedak, K., Kolts, I., Kask, K. Do Articular-Sided Partial-Thickness Rotator Cuff Tears After a First-Time Traumatic Anterior Shoulder Dislocation in Young Athletes Influence the Outcome of Surgical Stabilization? Orthop J Sports Med. 2018;6(6):232596711878131. doi:10.1177/2325967118781311.
16. Dow, D. F., Mehta, K., Xu, Y., England, E. The Relationship Between Body Mass Index and Fatty Infiltration in the Shoulder Musculature. J Comput Assist Tomogr. 2018;42(2):323-329. doi:10.1097/rct.0000000000000672.
17. Yamamoto, N., Mineta, M., Kawakami, J., Sano, H., Itoi, E. Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders. Am J Sports Med. 2017;45(11):2524–2531. doi:10.1177/0363546517709780.
18. Ranebo, M., C., Björnsson Hallgren, H., C., Adolfsson, L., E. Patients with a long-standing cuff tear in one shoulder have high rates of contralateral cuff tears: a study of patients with arthroscopically verified cuff tears 22 years ago. JSES. 2018;27(3):e68–e74. doi:10.1016/j.jse.2017.10.007.
19. Camurcu, Y., Ucpunar, H., Ari, H., Duman, S., Cobden, A., Sofu, H. Predictors of allocation to surgery in patients older than 50 years with partial-thickness rotator cuff tear. JSES. 2019;28(5):828-832. doi:10.1016/j.jse.2018.12.014.
20. Gereli, A., Kocaoglu, B., Ulku, T. K., Silay, S., Kilinc, E., Uslu, S., Nalbantoglu, U. Completion repair exhibits increased healing characteristics compared with in situ repair of partial thickness bursal rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 2018;26(8):2498–2504. doi:10.1007/s00167-018-4870-1.
21. Hahn, S., Lee, Y., H., Chun, Y., M., Park, E., H., Suh, J., S. Magnetic resonance arthrography results that indicate surgical treatment for partial articular-sided supraspinatus tendon avulsion: a retrospective study in a tertiary center. Acta Radiologica. 2017;58(9), 1115–1124. doi:10.1177/0284185116684673.
22. Hohmann, E., Shea, K., Scheiderer, B., Millett, P., Imhoff, A. Indications for Arthroscopic Subacromial Decompression. A Level V Evidence Clinical Guideline. Arthroscopy. 2019;36(3):913-922. doi:10.1016/j.arthro.2019.06.012
23. Kim, Y., S., Lee, H., J., Bae, S., H., Jin, H., Song, H. S. Outcome Comparison Between in Situ Repair Versus Tear Completion Repair for Partial Thickness Rotator Cuff Tears. Arthroscopy. 2015;31(11):2191–2198. doi:10.1016/j.arthro.2015.05.016.
24. Lacheta, L., Millett, P., J. Editorial Commentary: Is Arthroscopic In Situ Repair Effective for Long-Term Functional Recovery and Pain Relief in Symptomatic Partial Rotator Cuff Tears? Arthroscopy. 2019;35(3):703–705. doi:10.1016/j.arthro.2018.12.010.
25. Ono Y, Woodmass JM, Bois AJ, Boorman RS, Thornton GM, Lo IK. Arthroscopic Repair of Articular Surface Partial-Thickness Rotator Cuff Tears: Transtendon Technique versus Repair after Completion of the Tear—A Meta-Analysis. Adv Orthop. 2016;2016: 7468054. doi:10.1155/2016/7468054.
26. Ranalletta, M., Rossi, L., A., Bertona, A., B., Atala, N., A., Tanoira, I., Maignon, G., Bongiovanni, S., L. Arthroscopic Transtendon Repair of Partial-Thickness Articular-Side Rotator Cuff Tears. Arthroscopy. 2016;32(8):1523–1528. doi:10.1016/j.arthro.2016.01.027.
27. Rossi, L., A., Atala, N., A., Bertona, A., Bongiovanni, S., Tanoira, I., Maignon, G., Ranalletta, M. Long-Term Outcomes After In Situ Arthroscopic Repair of Partial Rotator Cuff Tears. Arthroscopy. 2019; 35(3):698-702. doi:10.1016/j.arthro.2018.09.026.
28. Shin SJ, Jeong JH, Jeon YS, Kim RG. Preservation of bursal-sided tendon in partial-thickness articular-sided rotator cuff tears: a novel arthroscopic transtendon anatomic repair technique. Arch Orthop Trauma Surg. 2016;136(12):1701–1708. doi:10.1007/s00402-016-2546-1.
29. Zafra M, Uceda P, Muñoz-Luna F, Muñoz-López RC, Font P. Arthroscopic repair of partial-thickness articular surface rotator cuff tears: single-row transtendon technique versus double-row suture bridge (transosseous equivalent) fixation: results from a prospective randomized study. Arch Orthop Trauma Surg. 2020;10.1007/s00402-020-03387-6.
30. Fukuta, S., Amari, R., Tsutsui, T. Double Arthroscopic Transtendon Repair of Partial-Thickness Articular Surface Tears of the Rotator Cuff: A Surgical Technique. J Orthop Surg. 2015;23(3):395–397. doi:10.1177/230949901502300329.
31. Osti, L., Buda, M., Andreotti, M., Osti, R., Massari, L., Maffulli, N. Transtendon repair in partial articular supraspinatus tendon tear. Br Med Bull. 2017;123(1):19–34. doi:10.1093/bmb/ldx023.
32. Heuberer, P., R., Smolen, D., Pauzenberger, L., Plachel, F., Salem, S., Laky, B., et al. Longitudinal Long-term Magnetic Resonance Imaging and Clinical Follow-up After Single-Row Arthroscopic Rotator Cuff Repair: Clinical Superiority of Structural Tendon Integrity. The Am J Sports Med.2017;45(6):1283–1288. doi:10.1177/0363546517689873..

How to Cite this article: Kokkineli S, Brilakis E, Antonogiannakis E. Partial Rotator Cuff Tears: a review of the literature. Journal of Clinical Orthopaedics July-Dec 2020;5(2):30-34.

 (Abstract    Full Text HTML)   (Download PDF)

Posterior shoulder instability

Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020   | page: 31-35 | E. Taverna, A.Spreafico, C. Perfetti, V. Guarrella

Author: E. Taverna [1], A.Spreafico [1,2], C. Perfetti [1], V. Guarrella [1]

[1] IRCCS Istituto ortopedico Galeazzi, Milan, Italy
[2] Università degli studi di Milano, Scuola di specializzazione in Ortopedia e Traumatologia

Address of Correspondence
Dr. E. Taverna,
IRCCS Istituto ortopedico Galeazzi, Milan, Italy


Normally, shoulder movements are well balanced through an interplay between static structures (bone and soft tissues as capsule, ligaments and labrum) and muscular dynamic stabilizers (muscles and tendons). Dysfunction of one or more of these components due to an injury, degeneration or congenital abnormalities may lead to shoulder instability with concomitant pain and dysfunction. This article provides an overview of the soft tissue and bony anatomy of the shoulder joint and pathopysiology of shoulder instability. It also covers the important aspects of clinical examination and special test for diagnosis of shoulder instability. A brief over view of conservative and surgical management protocols for shoulder instability are also covered in view of recent literature and authors experience.
Keywords: Posterior shoulder instability, conservative treament, Surgical management, arthroscopy.


1. Robinson CM, Dobson RJ. Anterior instability of the shoulder after trauma. J Bone Joint Surg [Br] 2004;86-B(4):469–479.
2. Rowe CR, Yee LB. A posterior approach to the shoulder. J Bone Joint Surg. 1944;26:580.
3. Steinmann SP. Posterior shoulder instability. Arthroscopy 2003; 19 Suppl 1: 102
4. Owens BD, Duffey ML, Nelson BJ, et al. The incidence and characteristics of shoulder instability at the United Statesmilitary academy. Am J Sports Med. 2007;35:1168–1173.
5. Robinson CM, Aderinto J. Current concepts review: recurrent posterior shoulder instability. J Bone Joint Surg Am. 2005;87: 883–892.
6. Tannenbaum EP, Sekiya JK. Posterior shoulder instability in the contact athlete. Clin Sports Med. 2013;32:781–796.
7. Brewer BJ, Wubben RC, Carrera GF. Excessive retroversion of the glenoid cavity. A cause of non- traumaticposterior instability of the shoulder. J Bone Joint Surg Am. 1986;68:724–31.
8. Dekker TJ, Peebles LA, Goldenberg BT, Millett PJ, Bradley JP, Provencher MT. Location of the Glenoid Defect in Shoulders With Recurrent Posterior Glenohumeral Instability. Am J Sports Med. 2019 Oct 16:363546519876282
9. Meyer DC, Ernstbrunner L, Boyce G, Imam MA, El Nashar R, Gerber C. Posterior Acromial Morphology Is Significantly Associated with Posterior Shoulder Instability.J Bone Joint Surg Am. 2019 Jul 17;101(14):1253-1260.
10. Blasier RB, Soslowsky LJ, Malicky DM, Palmer ML. Posterior glenohumeral subluxation: active and passive stabilization in a biomechanical model. J Bone Joint Surg Am 1997; 79: 433-440.
11. Kim S, Ha K, Park J, Kim Y, Lee Y, Lee J, Yoo J. Arthroscopic posterior labral repair and capsular shift for traumatic unidirectional recurrent posterior subluxation of the shoulder. J Bone Joint Surg Am. 2003;85:1479–87.
12. Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32:413–418.
13. Saliken DJ, Bornes TD, Bouliane MJ, Sheps DM, Beaupre LA. Imaging methods for quantifying glenoid and Hill-Sachs bone loss in traumatic instability of the shoulder: a scoping review. BMC Musculoskelet Disord. 2015 Jul 18;16:164.
14. Burkhead Jr WZ, Rockwood Jr CA. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am. 1992;74:890–6.
15. McIntyre K, Be´langer A, Dhir J, et al. Evidence-based conservative rehabilitation for posterior glenohumeral instability: a systematic review. Phys Ther Sport. 2016;22:94–100.
16. Schwartz E, Warren RF, O’Brien SJ, Fronek J. Posterior shoulder instability. Orthop Clin N Am. 1987;18:409–19.
17. Woodmass JM, Lee J, Johnson NR, Wu IT, Camp CL, Dahm DL, Krych AJ. Nonoperative Management of Posterior Shoulder Instability: An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 10 Years After Diagnosis. Arthroscopy. 2019 Jul;35(7):1964-1970.
18. Saupe N, White LM, Bleakney R, Schweitzer ME, Recht MP, Jost B, Zanetti M. Acute traumatic posterior shoulder dislocation: MR findings. Radiology 2008; 248: 185-193.
19. Peat M. Functional anatomy of the shoulder complex. Phys Ther 1986; 66: 1855-1865.
20. Barbier O, Ollat D, Marchland JP, Versier G. Iliac bone-block autograft for posterior shoulder instability. Rev Chir Orthop Traumatol. 2009;95:100–7.
21. Métais P, Grimberg J, Clavert P, Kouvalchouk JF, Sirveaux F, Nourissat G, Garret J, Mansat P, Godenèche A; French Arthroscopy Society. Posterior shoulder instability managed by arthroscopic acromial pediculated bone-block. Technique. Orthop Traumatol Surg Res. 2017 Dec;103(8S):S203-S206
22. D’Ambrosi R, Perfetti C, Garavaglia G, Taverna E. One step arthroscopically assisted Latarjet and posterior bone-block, for recurrent posterior instability and anterior traumatic dislocation. Int J Shoulder Surg. 2015 Jul-Sep;9(3):94-8
23. Cerciello S, Enrico V, Morris BJ, Corona K. Bone block procedures in posterior shoulder instability. Knee Surg Sports Traumatol Arthrosc. 2016;24(2):604–11.
24. Inui H, Nobuhara K.Glenoid osteotomy for atraumatic posteroinferior shoulder instability associated with glenoid dysplasia. Bone Joint J 2018;100-B:331-7.
25. Mc LH. Posterior dislocation of the shoulder. J Bone Joint Surg Am. 1952;24 a:584–590.
26. Dueya RE, Burkhart SS. Arthroscopic treatment of a reverse Hill-Sachs lesion. Arthrosc Tech. 2013;2:e155–9.
27. Meuffels DE, Schuit H, van Biezen FC, Reijman M, Verhaar JA. The posterior bone block procedure in posterior shoulder instability: a long-term follow-up study. J Bone Joint Surg Br 2010; 92: 651-655
28. Bradley JP, McClincy MP, Arner JW, Tejwani SG. Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 200 shoulders. Am J Sports Med 2013; 41: 2005-2014
29. Seppel G, Braun S, Imhoff AB. Surgical Management of Posterior Shoulder Instability. ISAKOS: Brockmeier SF, 2013.

How to Cite this article: Taverna E, Spreafico A, Perfetti C, Guarrella V. Posterior shoulder instability. Journal of Clinical Orthopaedics Jan-June 2020;5(1):31-35.

(Abstract    Full Text HTML)   (Download PDF)