Articular-sided Rotator Cuff Tears Research Articles

Superior capsule reconstruction: anatomy, biomechanics, indications, and graft treatment.

Superior capsule reconstruction: anatomy, biomechanics, indications, and graft treatment.

“Ninja Technique” for Percutaneous Completion of Partial-Thickness, Articular-Sided Rotator Cuff Tears

Rotator cuff tears are a common source of shoulder pain and dysfunction. Owing to the multifaceted nature of these injuries, various viable methodologies exist for their surgical and nonsurgical management. Among surgically managed patients, those with PASTA (partial articular supraspinatus tendon avulsion) lesions require careful consideration of technique. Both transtendinous repair and tear completion with subsequent repair have been described. Both techniques offer unique benefits. In this publication, we offer an expedient and minimally invasive technique for tear completion and subsequent repair. The “ninja technique” uses localization via a spinal needle and tear completion with an arthroscopically manipulated scalpel blade. Conversion of partial tears to full-thickness tears using the ninja technique allows for technically simplified repairs while maximizing available tendon length.

Repairing PASTA Lesions Without Violation of the Rotator Cuff

Partial-thickness articular-sided rotator cuff tears are a common cause of shoulder pain in adults. Although partial rotator cuff tears have a high prevalence, there is still controversy over their proper surgical treatment. Different surgical procedures have been suggested when partial tears involve the articular side of the rotator cuff, such as arthroscopic debridement of the tear with or without acromioplasty, tear completion and repair, and transtendinous in situ repair. Although multiple repair techniques have been described, significant clinical data to definitively support one technique over the others are currently lacking. We describe an arthroscopic technique for repair of a partial articular supraspinatus tendon avulsion that avoids the transtendinous insertion of suture anchors to preserve the tendon integrity.

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.

The purpose of this prospective study was to compare the clinical and structural findings following the arthroscopic repair of partial-thickness (exceeding 50%) articular-sided rotator cuff tears using either a single-row or a double-row suture bridge fixation. Fifty patients were included in this study. The patients were randomly placed into two groups: 25 underwent the single-row (Group I) and 25 a double-row suture bridge fixation (Group II). The clinical outcomes were assessed using ASES and Constant shoulder scores, both preoperatively and at the end of follow-up. The pain level was evaluated using the visual analogue scale (VAS), preoperatively, at 6months and at the end of follow-up. All patients underwent preoperative MRI to identify the rotator cuff tear, and postoperatively at 12months to evaluate tendon integrity. The average follow-up was 32.5months. The mean ASES scores increased from 35.9 to 96.7 in Group I and from 35.3 to 93.4 in Group II; the mean Constant shoulder scores increased from 55.6 to 97.8 in Group I and from 57.5 to 97.3 in Group II. There were no significant differences between the two groups. The average preoperative pain level decreased from 7.4 to 3 at 6months and to 0.4 at the end of the Group I; and from 7.6 to 3 at 6months and 0.8 in Group II. There was no significant difference between the two groups. At 12months, the MRI assessments showed two retears in Group I (8%) and one retear in Group II (4%). Arthroscopic repair of partial-thickness articular rotator cuff tears that exceed 50% of tendon thickness with a single-row transtendon repair or double-row suture bridge provides functional improvement and pain relief regardless of the repair technique used. There were no differences in clinical results between both techniques. Level II; prospective comparative study.

Partial-thickness rotator cuff tear: the secret of spinal needle

Aim The aim of this study is to prospectively evaluate the functional outcome after repair of PTRCT, moreconcisely partial-thickness articular surface tear, through converting it into complete tear and repairing in a routine manner using a spinal needle as a guideline for localization of the tear. Objectives Repair of PTRCT, through converting it into complete tear and repairing in a routine manner using a spinal needle. Background Partial-thickness rotator cuff tears (PTRCTs) involve all tears that do not connect the subacromial space with the glenohumeral joint but the fibers are disrupted. They may be articular-side tear, intertendinous tears, or bursal-side tears. The histopathological changes leading to rotator cuff rupture are gradual and progressive. The exact location and extent of incomplete tear can be shown by shoulder arthroscopy. Methods A total of 50 patients who underwent arthroscopic repair for a partial-thickness articular-sided rotator cuff tear between March 2013 and July 2015 were included in this study. Results Range of motion of the shoulder preoperatively was forward elevation of 135 5.6, mean external rotation of 44 3.5, and mean internal rotation of L3 level. Postoperatively, the range finally improved significantly to forward elevation of 165 4, external rotation of 60 5, and internal rotation of L1 level. Conclusions The use of spinal needle in arthroscopic repair of PTRCT facilitates the site of tear and as a guide for the healthy bursal side of the cuff. The limitations of our study included patient were highly selected regarding PTRCT and there was no postoperative imaging study.

Partial articular supraspinatus tendon avulsion: Should we repair? A systematic review of the evidence.

Partial articular sided rotator cuff tears are described as being a common cause of shoulder pain and to have a significant impact of patient quality of life. The natural history of partial articular supraspinatus tendon avulsion lesions is not clearly defined and there is limited evidence to determine optimal management. To perform a systematic review of the literature regarding the evidence for partial articular supraspinatus tendon avulsion repair and to determine whether there is any difference between operative and non-operatively managed patients. Conventional and grey literature were searched with defined terms to identify studies in human adults concerning management of partial articular sided supraspinatus avulsions. Out of 86 papers identified by the search terms, 28 were deemed eligible for review including 1966 shoulders. 4/28 papers were of level I-II evidence but all were comparing techniques. 4/28 papers were biomechanical cadaveric studies, assessing strength of repair and effect on stability. The remaining 20 studies were level IV-V evidence and consisted of case series and technical notes identifying varying techniques of repair and their outcomes. Current literature suggests that all techniques used to repair partial articular supraspinatus tendon avulsion lesions give increased functional scores and reduced pain. However, this represents a heterogeneous group of patients with variable degrees of tear and is not reproducible. There are limited controlled studies to determine whether partial articular supraspinatus tendon avulsion lesions require repair. Current classification systems represent a single plane and are open to user variation. No evidence exists to determine which tears are stable and which may progress.

Double Row–Equivalent PASTA Repair Technique

Articular surface partial rotator cuff tendon tears are a common source of shoulder pain and dysfunction, and there is no consensus regarding the optimal arthroscopic treatment. Commonly accepted techniques, such as transtendinous repair or tear takedown with primary repair, may violate healthy tendon tissue and increase the suture anchor density. In this note, we describe an outside-in double row–equivalent technique for repair of partial articular-sided rotator cuff tears. A medial row of inverted horizontal mattress stitches is placed percutaneously using spinal needles to shuttle partially absorbable braided sutures into the joint. The technique may incorporate a soft tissue biceps tenodesis into the rotator cuff with a second, oblique medial row mattress stitch. Suture limbs are retrieved and tied in the subacromial space and then secured to a lateral anchor. The result is a side-to-side double row–equivalent rotator cuff repair, anatomically reproducing the footprint of the rotator cuff without removing healthy tissue. We believe this is an efficient and reproducible technique that preserves intact bursal tissue, limits implant costs, and produces reliable healing in partial articular-sided tears of the rotator cuff.

Pathoanatomy of Shoulder Instability in Collegiate Female Athletes

Background: Shoulder instability has been well described in young men; however, few studies have specifically evaluated the pathoanatomy and unique spectrum of injuries in women with shoulder instability. Purpose: To describe the pathoanatomy of operative shoulder instability in a collegiate female cohort. Study Design: Case series; Level of evidence, 4. Methods: The authors performed a retrospective analysis of a consecutive series of female students at a National Collegiate Athletic Association Division I military service academy treated operatively for shoulder instability by a single surgeon between September 2008 and September 2014. Preoperative data collected included patient age, sport, mechanism of injury, number and frequency of dislocations, direction of instability, and co-occurring surgical abnormalities at the time of arthroscopy. Outcome variables included recurrent instability after surgery and need for revision. Results: Thirty-six female student athletes with an average age of 20 years (range, 18-22 years) were included. The majority of instability events were traumatic in nature (69%), and 61% of the total events were subluxations. Rugby was the most common sport for experiencing instability (7 patients), followed by obstacle course training (6 patients). Thirty-two patients (89%) reported multiple instability events, averaging 4 per shoulder. The primary direction of instability was anterior in 26, combined anterior and posterior in 7, and 3 met criteria for multidirectional instability. At the time of surgery, 26 patients (72%) had a Bankart tear, 9 (25%) had a posterior labral tear, and 5 (14%) had superior labrum anterior to posterior tears. Nine patients (25%) were found to have humeral avulsion of the glenohumeral ligament (HAGL) lesions, 7 (19%) had partial-thickness articular-sided rotator cuff tears, and only 1 patient (3%) had evidence of true attritional glenoid bone loss. Hill-Sachs lesions were found in 16 patients (44%). Recurrent instability occurred in 9 patients (25%) following arthroscopic stabilization, and revision surgery was performed in 6 (17%). Conclusion: Shoulder instability in female athletes presents commonly as multiple subluxation events. While soft tissue Bankart lesions were found in numbers equal to those in previous studies include both sexes, bony Bankart lesions were less common in women. Finally, the presence of combined anterior and posterior labral tears and HAGLs in women was more common than previously reported.

The PASTA Bridge – A Repair Technique for Partial Articular-Sided Rotator Cuff Tears: A Biomechanical Evaluation of Construct Strength

Partial articular-sided supraspinatus tendon avulsion (PASTA) tears are a common clinical problem that can require surgical intervention to reduce patient symptoms. Currently, no consensus has been reached regarding the optimal repair technique. The PASTA Bridge technique was developed by the senior author to address these types of lesions. A controlled laboratory study was performed comparing the PASTA Bridge with a standard transtendon rotator cuff repair to confirm its biomechanical efficacy. A 50% articular-sided partial tear of the supraspinatus tendon was created on 6 matched pairs of fresh-frozen cadaveric shoulders. For each matched pair, 1 humerus received a PASTA Bridge repair, whereas the contralateral side received a repair using a single suture anchor with a horizontal mattress suture. The ultimate load, yield load, and stiffness were determined from the load-displacement results for each sample. Video tracking software was used to determine the cyclic displacement of each sample at the articular margin and the repair site. Strain at the margin and repair site was then calculated using this collected data. There were no significant differences between the 2 repairs in ultimate load (P = .577), strain at the repair site (P = .355), or strain at the margin (P = .801). No instance of failure was due to the PASTA Bridge construct itself. The results of this study have established that the PASTA Bridge is biomechanically equivalent to the transtendon repair technique. The PASTA Bridge is technically easy, percutaneous, reproducible, and is associated with fewer risks.

Arthroscopic knotless single-row repair preserving full footprint versus tear completion repair for partial articular-sided rotator cuff tear.

The comparison of clinical outcomes of arthroscopic footprint-preserving knotless single-row repair with the tear completion repair technique for articular-sided partial-thickness rotator cuff tears (PTRCTs) remains unclear. A total of 68 patients diagnosed with articular-sided PTRCTs who underwent rotator cuff repair between December 2014 and June 2015 were included. Of the 68 patients, 30 received footprint-preserving knotless single-row repair (group 1) and 38 received the tear completion repair technique (group 2). Preoperative and postoperative assessments were compared. Both groups had significantly improved American Shoulder and Elbow Surgeons (ASES) scores (group 1: 48.2 preoperatively to 81.9 postoperatively, p < 0.001; group 2: 47.1 preoperatively to 84.9 postoperatively, p < 0.001) and visual analog scale (VAS) pain score (group 1: 6.0 preoperatively to 0.93 postoperatively, p < 0.001; group 2: 6.1 preoperatively to 1.1 postoperatively, p < 0.001), showing that the two procedures significantly improved postoperative shoulder function. No significant differences were shown in ASES score or VAS pain score between the two groups ( p > 0.05). The mean operation time was significantly shorter in group 1 with an average of 48.1 min than in group 2 with an average of 60.4 min ( p < 0.001). Footprint-preserving knotless single-row repair obtains similar clinical results compared to tear completion repair in the treatment of articular-sided PTRCTs. Footprint-preserving knotless single-row repair may be a convenient choice for the treatment of articular-sided PTRCTs. Randomized controlled studies are needed to investigate whether the footprint-preserving knotless single-row repair yields better long-term outcomes through the protection of the bursal cuff and restoration of the healthy footprint.

Partial-thickness tears involving the rotator cable lead to abnormal glenohumeral kinematics

The objective of this study was to determine the biomechanical function of the rotator cable when a partial-thickness (>50%) tear is present. We compared intact specimens with partial tears of the anterior cable followed by partial anterior and posterior tears in regard to glenohumeral kinematics and translation. The hypothesis was that partial-thickness tears will lead to abnormal glenohumeral biomechanics, including glenohumeral translation and path of glenohumeral articulation. Five fresh frozen cadaveric shoulders with intact labrum, rotator cuff, and humerus were tested using a custom shoulder testing system in the scapular plane. Glenohumeral translation was measured after applying an anterior load of 30 N at different angles of external rotation. The path of glenohumeral articulation was measured by calculating the humeral head center with respect to the glenoid articular surface at 30°, 60°, 90°, and 120° of external rotation. With an anterior force of 30 N, there was a significant increase in anterior and total translation at 30° of external rotation after the anterior cable was cut (P < .05). When the tear was extended to the posterior cable, there was a significant increase in anterior, inferior, and total translation at 30° and 120° of external rotation (P < .05). With respect to the path of glenohumeral articulation , the humeral head apex was shifted superiorly at 90° and 120° of external rotation after the posterior cable was cut (P < .05). Partial-thickness articular-sided rotator cuff tears with a thickness >50% involving the rotator cable increased glenohumeral translation and changed kinematics in our cadaveric biomechanical model.

Ultrasound and Functional Assessment of Transtendinous Repairs of Partial-Thickness Articular-Sided Rotator Cuff Tears.

Background:Partial-thickness articular-sided rotator cuff tears are a frequent source of shoulder pain. Despite conservative measures, some patients continue to be symptomatic and require surgical management. However, there is some controversy as to which surgical approach results in the best outcomes for grade 3 tears.Hypothesis/Purpose:The purpose of this study was to evaluate repair integrity and the clinical results of patients treated with transtendinous repair of high-grade partial-thickness articular-sided rotator cuff tears. Our hypothesis was that transtendinous repairs would result in reliable healing and acceptable functional outcomes.Study Design:Case series; Level of evidence, 4.Methods:Twenty patients with a minimum follow-up of 2 years were included in the study. All patients underwent arthroscopic repair of high-grade partial-thickness rotator cuff tears utilizing a transtendinous technique by a single surgeon. At latest follow-up, the repair integrity was evaluated using ultrasound imaging, and functional scores were calculated.Results:Ultrasound evaluation demonstrated that 18 of 20 patients had complete healing with a normal-appearing rotator cuff. Two patients had a minor residual partial tear. Sixteen of 20 patients had no pain on visual analog scale. Four patients complained of mild intermittent residual pain. All patients were rated as “excellent” by both the University of California at Los Angeles Shoulder Score and the Simple Shoulder Test.Conclusion:The transtendon technique for the repair of articular-sided high-grade partial rotator cuff tears results in reliable tendon healing and excellent functional outcomes.

Arthroscopic Debridement of the Thrower's Shoulder: Less Is More

AbstractThe thrower's shoulder has long been a topic of debate among shoulder specialists. The tremendous forces produced during the throwing motion coupled with the compilation of the pathology encountered in the thrower's shoulder have generated a complex treatment algorithm. Simplifying management options has been challenging and recommendations continue to evolve. Treatment of injuries to the thrower's shoulder most commonly involves addressing partial articular-sided rotator cuff tears. These can be isolated or more commonly associated with tearing of the posterior superior labrum. The understanding of the dramatic difference between the surgical treatment of shoulder injuries in overhead athletes and nonoverhead athletes is paramount to positive outcomes after surgery.

Preservation of bursal-sided tendon in partial-thickness articular-sided rotator cuff tears: a novel arthroscopic transtendon anatomic repair technique.

The purpose of this study was to introduce a novel arthroscopic transtendon anatomic repair technique that spares the intact bursal-sided tendon in articular-sided partial-thickness rotator cuff tears (PTRCT) and to present shoulder functional outcomes in patients with symptomatic articular-sided PCRCT that involves more than 50% of its thickness after arthroscopic repair using a novel technique. Eighteen patients with symptomatic articular-sided PCRCT involving more than 50% of the tendon's thickness underwent arthroscopic repair using a devised technique. The devised technique restores only the torn articular portion of the rotator cuff at the anatomical footprint using a suture anchor, and preserves the integrity of the corresponding bursal-sided tendon by tying knots at the most lateral bursal side on the subacromial space. Clinical and functional outcome using ASES and Constant scores were evaluated. The structural integrity of the rotator cuff was evaluated by MRI at 6months postoperatively. Pain relief and shoulder functional outcomes were encouraging during the recovery phase after operation. ASES (preoperative 54.0±10.3 to postoperative 92.6±8.0), Constant score (61.2±8.5-88.0±5.3), VAS for pain (4.9±2.6-0.6±0.7) improved significantly after arthroscopic transtendon anatomic repair (p<0.001). No patients had rotator cuff retears on 6-month MRI. No complications related to surgical procedures had occurred. The devised technique of arthroscopic transtendon repair provided satisfactory functional outcomes without postoperative discomforts. This technique minimizes over-tightening of the articular layer and reduces tension mismatches between the articular and bursal layers, which are considered as important factors for improvement of postoperative shoulder motion.

Grade of coracoacromial ligament degeneration as a predictive factor for impingement syndrome and type of partial rotator cuff tear

The purpose of this study was to investigate the role of coracoacromial ligament degeneration and specific anatomic parameters in the etiology of partial-thickness rotator cuff tears. This study retrospectively assessed 96 patients (mean age, 50.1 years [17-76]; 34 men, 62 women) diagnosed with bursal-side and articular-side rotator cuff tears with a history of failed conservative treatment and persistent shoulder pain who underwent arthroscopic surgery. Video records of the surgery were used to evaluate the type of cuff tear, grade of coracoacromial ligament degeneration, and associated pathologic changes; preoperative magnetic resonance images were used to measure acromioglenoid angle, supraspinatus glenoid angle, and subacromial distance. Most of the patients with articular-side tears demonstrated grade 0 and grade 1 coracoacromial ligament degeneration, whereas patients with bursal-side tears had grade 1 and grade 2. There was a significant positive correlation between the grade of coracoacromial ligament degeneration and bursal-side partial rotator cuff tears, whereas no correlation was observed with articular-side tears. There was no significant difference between bursal-side and articular-side partial cuff tears regarding acromioglenoid angle, supraspinatus glenoid angle, and subacromial distance. Grade 1 and grade 2 coracoacromial ligament degeneration is a strong predictive factor for impingement syndrome in the etiology of bursal-side partial cuff tears and can guide the surgeon to consider ligament release and débridement or acromioplasty in these patients.

Arthroscopic transtendon repair of partial articular-sided supraspinatus tendon avulsion.

To evaluate the outcomes of arthroscopic transtendon repair of partial articular-sided supraspinatus tendon avulsion (PASTA) in a large study group. A retrospective review of prospectively collected data was conducted. One hundred and eighteen patients with PASTA lesion (grade A2-A3) who underwent arthroscopic transtendon repair were identified, of which 110 were eligible for the study. Ten patients were lost at final follow-up leaving a study group of 100 patients (52 male, 48 female). The average follow-up was 37months (minimum 24months, range 24-50, median 40). Mean age at the time of surgery was 50.4 (range 17-71, median 45). Patients were assessed before surgery and at 24-month follow-up, using the Simple Shoulder Test (SST), UCLA shoulder rating scale and the visual analogue scale (VAS). ROM was measured bilaterally and was evaluated before surgery, at 3-, 6- and 24-month follow-up. The satisfaction rate was calculated. Data were analysed using a paired Student's t test with 95% confidence interval (significance p<0.05). Significant improvement in UCLA, SST and VAS score was observed. Fifty-four cases were rated excellent, 42 good, 2 fair, 2 poor according to the UCLA score. No significant differences in ROM were noted compared to the contra-lateral side (p<0.001) at the 24-month follow-up. Eighteen patients presented with a stiff shoulder at the 3-month follow-up, but they recovered full ROM by the 6-month follow-up evaluation. The arthroscopic transtendon repair of partial articular-sided rotator cuff tears is an effective procedure that leads to significant improvement in pain and shoulder function, with high patients' satisfaction rate, while the complication rate is low. This study demonstrated the effectiveness and safety of this technique in a large homogeneous study group. IV.

Arthroscopic Transtendon Repair of Partial-Thickness Articular-Side Rotator Cuff Tears

To evaluate the clinical outcomes and complications in a series of patients with painful partial articular cuff tears treated with the arthroscopic transtendinous repair with a minimum 2-year follow-up. Eighty patients with a mean age of 51 ± 5.4years who had undergone an arthroscopic transtendon repair for a painful articular-sided rotator cuff tear with a minimum of 2-year follow-up were contacted. Clinical outcomes using a patient-based questionnaire, the University of California at Los Angeles score, the American Shoulder and Elbow Surgeons score, and the visual analog scale were evaluated. Postoperative complications were also assessed. After arthroscopic repair, the University of California at Los Angeles scores improved from 13.6 to 31.5; the American Shoulder and Elbow Surgeons scores improved from 44.4 to 76.1; and the visual analog scale scores improved from 6.3 to 1.3 (P < .0001). A total of 92.5% of patients were satisfied with their results. Only 5 patients developed a postoperative adhesive capsulitis that responded favorably to physical therapy. Eleven patients had concurrent procedures performed at the time of surgery. We found no difference between these patients and those who had an isolated tendon repair. Arthroscopic transtendon repair of partial-thickness articular-side rotator cuff tears is a reliable procedure that can be expected to produce satisfactory functional improvements and pain relief in most patients with a low rate of complications in the midterm follow-up. Concurrent procedures performed at the time of supraspinatus repair do not change functional outcomes. Level IV, therapeutic case series.

Diagnostic shortcomings of magnetic resonance arthrography to evaluate partial rotator cuff tears in adolescents.

Recent evidence suggests an increase in the incidence of partial articular-sided rotator cuff tears in adolescent athletes, but the accuracy of diagnostic studies has not been previously assessed in this cohort. This study was performed to assess the ability of magnetic resonance imaging with arthrography (MRIa) to diagnose partial rotator cuff (PRC) pathology in the adolescent age group. All patients under the age of 19 years who underwent shoulder arthroscopy, between August 2008 and August 2010, were grouped based on the presence of a PRC tear diagnosed by either MRIa or arthroscopy. The control cohort included children without evidence of an intraoperative PRC. Surgical findings were then correlated with the preoperative MRIa findings and the accuracy of MRIa reading. Interclass coefficient was then determined for the MRIa reviewers. Thirty-one of 89 adolescents (mean age, 15.9 y; 36% girls and 64% boys) who underwent arthroscopic shoulder surgery were found to have radiographic or arthroscopic evidence of a PRC injury. There were 17 boys and 14 girls in the PRC group, with a mean age of 15.6 years. The PRC injuries involved either the supraspinatus tendon, infraspinatus tendon, or both. MRIa was 44% sensitive and 87% specific, with a positive predictive value of 64% and a negative predictive value of 74% with arthroscopic findings used as the gold standard. The ICC between reviewers was κ=0.57, with an absolute agreement of 84%. The overall diagnostic accuracy of the MRIa with regard to adolescent PRC injuries was 72%. MRIa was found to be specific, but not sensitive for the diagnosis of this pathology. The high false-negative rate seen in this adolescent cohort indicates that a PRC injury may be present even with a negative MRIa. Therefore, if clinical suspicion indicates a PRC injury, then the treating physician should consider management for rotator cuff pathology despite negative MRIa findings. Level III--retrospective cohort study.

Which is the best repair of articular-sided rotator cuff tears: a meta-analysis.

BackgroundTear conversion followed by repair and trans-tendon techniques have been widely used for partial-thickness rotator cuff tears. Both of them showed favorable results with regard to the management of articular-sided partial-thickness rotator cuff tears (PTRCTs) of more than 50 % thickness. However, controversy continues with the best management. This study aims to compare the clinical outcomes between the two techniques.MethodsThe PubMed, Embase, and Cochrane library databases were searched for relevant studies published before October 1, 2014. Studies that clearly reported a comparison between the two procedures were selected. The American Shoulder and Elbow Surgeons scale (ASES) and the re-tear rate were evaluated. Statistical analysis was performed using the special meta-analysis software called “Comprehensive Meta Analysis”.ResultsFinal meta-analysis after the full-text review included four studies about tear conversion followed by repair and seven studies about trans-tendon technique. The trans-tendon technique showed no significant difference with the tear conversion followed by repair technique with regard to the ASES scale (P = 0.69). But the re-tear rate (P < 0.05) was markedly lower in the trans-tendon technique group than the tear conversion and repair technique group.ConclusionIn conclusion, the meta-analysis suggests that the trans-tendon technique is better than the tear conversion followed by repair technique with regard to the management of articular-sided PTRCTs of more than 50 % thickness in the re-tear rate aspect.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-015-0224-6) contains supplementary material, which is available to authorized users.

Die Werferschulter

During the throwing motion high forces are placed on the athlete's shoulder and extreme positions of external rotation and abduction are reached. The dynamic and static stabilizers of the glenohumeral joint need to handle a delicate balance between shoulder mobility and stability. Repetitive forces lead to adaptive osseous, capsular, ligament and muscular changes. This should increase external rotation of the shoulder and thus initially help to improve performance but ultimately could cause shoulder pathologies. For instance, tissue overuse can result in muscular imbalance, functional instability and posterior capsular contracture with the development of a glenohumeral internal rotation deficit. An internal impingement is often observed in throwing athletes which can be subdivided into the more common posterosuperior type and the rarer anterosuperior type. Typical lesions in the throwing shoulder are articular-sided partial rotator cuff tears, labrum and biceps tendon lesions and edema, cysts or osteochondral lesions of the humeral head or glenoid. For an accurate diagnosis it is important to include the history, a thorough physical examination and magnetic resonance arthrography. The correlation of clinical examination and imaging is critical to identify symptomatic lesions. If conservative therapy fails or in cases of significant structural damage resulting in clinical symptoms, surgical treatment should be considered based on the underlying pathology and carried out using established techniques and criteria.