Arthroscopic management of bursal sided rotator cuff tears, In situ repair vs conversion. A Systematic Review of Literature

Abstract

Abstract Background and Rational Rotator cuff tears are a common source of pain and dysfunction in various groups of age and occupation. The tear can either be complete or partial thickness rotator cuff tears (PTRCTs). PTRCTs involving <50% of the thickness have been managed arthroscopically by debridement alone without acromioplasty. While massive PTRCTs involving more than 50% were repaired either arthroscopically by convergence to full thickness tears then tendon repair or in situ repair. There is no widely accepted technique in repairing Bursal sided PTRCTs. This study is to conduct a systematic review to compare the results of two of the most commonly used surgeries for management of bursal side rotator cuff tears, repair in situ vs tear completion then repair, as the search for the optimal surgery is crucial to improve long term outcomes, decrease side effects and costs and enhance patient quality of life. Methodology The search was conducted using the databases Medline, PubMed, Medscape, Cochrane library, using the following keywords: “partial rotator cuff tears”, “ bursal sided tears”, “in situ” “convergence” and “arthroscopic management” for published studies from 1990 to 2018. Results Our search included 11 studies, 5 tear completion, 4 repair in situ and 2 were comparative of both techniques. Studies showed insignificant difference in clinical outcomes between both surgical procedures, both repair in situ and tear completion techniques produce good results in rotator cuff tears techniques thus both remain in their places in management of bursal side rotator cuff tears. Conclusion Both in situ and tear completion techniques remain in their places in management of bursal side rotator cuff tears. We suggest that the final consensus should be postponed until further studies are the future, systematic reviews & comparative studies with longer term follow up period are needed to evaluate and guide for the best arthroscopic management of bursal side rotator cuff tears.