What did the study look at?
The authors note that, thanks to better imaging and arthroscopy, partial rotator cuff tears are being diagnosed more often, yet the best treatment plan remains uncertain. One repair option is to convert the partial tear into a full-thickness tear and then repair it; another is to repair it by passing through the tendon (transtendon repair). The authors state that the latter has practical challenges and requires experience.
The aim was to develop an easy technique that repairs the partial tear without converting it to a full-thickness tear, working only from the upper (bursal) side of the tendon. This is a surgical technique article, not a study measuring patient outcomes.
How was it done?
The article describes these steps:
- The patient is placed in the beach-chair position and diagnostic arthroscopy is performed through standard portals.
- The joint-sided supraspinatus tear and the tendon's attachment area (footprint) are debrided, and the tear is marked with a Prolene suture.
- The arthroscope is moved to the space beneath the acromion, the bursa is removed, and the marking suture is found and preserved.
- A 4.5 mm anchor is placed into the greater tuberosity of the upper arm bone, aligned with the marking suture.
- The anchor's two sutures are passed through the tendon at a near and a far point, centred on the marking suture, forming a triangle, and are then tied.
The authors stress checking from inside the joint that the sutures have not passed through the biceps tendon. The accompanying video shows the technique in the right shoulder of a 44-year-old man.
What did it find?
The article does not report numerical outcomes or a patient series. The authors highlight these features of the technique:
- It is easy to perform and brings the torn end closer to the footprint.
- The sutures press the upper surface of the tendon onto the footprint.
- Unlike other transtendon repairs, it causes minimal damage to the tendon's integrity and to the joint cartilage.
According to the authors, the suture at the base of the triangle seats the tear on the footprint, while the second suture strengthens its relationship with the bursal surface, so that progression of the tear from the joint side to the upper surface may be avoided.
The authors' conclusion
The authors concluded that the technique is a safe, effective and technically practical repair method for joint-sided partial tears of the rotator cuff.
Limitations
The authors state that the technique must not be used for tears with an intratendinous pattern. They also note as a risk that sutures can pass through the joint and that the biceps tendon must not be penetrated. As a technique description, the article does not include comparative outcome data.
Reference
Bozkurt M, Firat A, Gürsoy S, Akkaya M. 2015. Rotator Cerclage Technique for Partial Rotator Cuff Ruptures. Arthroscopy Techniques 4(5):e589-e593. Licence: CC BY-NC-ND 4.0.
DOI: 10.1016/j.eats.2015.07.004
Free full text: PubMed Central
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
