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Jin-Young Park, MD, PhD
Moon-Jib Yoo, MD, Phd
Myung-Ho Kim, MD, PhD ABSTRACT In 1987, Ellman designed the
arthroscopic acromioplasty, and this has progressed to the mini-open
repair for rotator cuff tears. There
is little in the current literature regarding outcomes for persons with
partial rotator cuff tears whom undergo arthroscopic acromioplasty and
debridement. Ellman placed
rotator cuff tears into the following groups:
articular side, bursal side, and intratendinous.
He suggested acromioplasty and debridement for tears that were less
than 50% of the thickness of the rotator cuff (which averages 12mm in
thickness), and surgical repair for tears that exceed 50%.
The natural course of a tear does
not appear to be healing, as there is reduced vascularity in the region,
continued impingement, and physical separation of the stump end.
Cadaver studies have indicated that partial thickness tears can
range from 13-32%, and tears on the articular side were more common than
bursal side, by 2-3x. Also,
athletes who throw overhead mostly had articular side lesions.
These authors used the data from 37
partial thickness rotator cuff tears that underwent decompression and
debridement between May 1994-1998. 24
were on the articular side, 13 were bursal, and with the average patient
age being 52. The dominant
arm accounted for a slightly higher percentage, and women were higher at
62%. The mean time from
symptom onset to surgery was 29 months in articular side lesions and 48
months for bursal side. The
average tear depth was 4.5mm for articular side tears, and 4.4mm for
bursal side tears. Tear
length was between 12-13mm on average.
8 patients during surgery revealed slight fraying of the superior
labrum, but not enough to yet be classified as a type I SLAP lesion.
23 of the tears also had synovitis at the posterior capsule. Post surgically, patients began
AROM and PROM, and the questionnaire used was the Research Committee of
American Shoulder & Elbow Surgeons (50 points for self-evaluation and
50 points for pain levels). At
6 months post-op, bursal side tears had significantly lower scores than
the articular side group. At
2-year follow-up, the bursal side group still had lower pain and greater
subjective gains, but the results were not significant. COMMENTS Having an understanding of what
kind of tear a patient currently has that you are treating, or that they
had prior to surgery, may be of benefit when monitoring their progress and
setting patient goals. Often,
this information is not even supplied by the surgeon, but communicating
and showing an understanding of the above listed classification criteria
may earn some respect and allow you to treat your patient better.
It is unfortunate that the bursal side tears do so well yet are the
lower frequency seen. The
authors note that this is the type of lesion usually seen in the elderly
after a fall, while the articular side lesion is more common in younger
individuals, often from trauma. If
an MRI report gives that depth and/or length of the tear, you may find the
information useful when treating a patient that was referred by a primary
care physician. A tear
greater than 50% may be temporarily relieved of symptoms, but will
probably progress with time. It
may depend upon the patient’s goals, age, and present life situation.
As long as they have the information they need to make the
decision.
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