From the Guidelines
The best treatment approach for a full thickness tear in the supraspinatus tendon near its footprint is early surgical repair, especially for acute tears, as it has been shown to have better results than delayed repair 1. This approach is based on the evidence that early surgical repair after acute injury is an option for patients with a rotator cuff tear, and that the timing of surgery can affect the outcome, with repairs performed within 3 weeks of injury having better results than those performed after 3 weeks 1. The treatment plan should include:
- Conservative management for 6-12 weeks, including physical therapy focusing on rotator cuff strengthening, anti-inflammatory medications, and activity modification
- Surgical options, such as arthroscopic repair with suture anchors to reattach the tendon to its footprint on the greater tuberosity of the humerus, if conservative treatment fails to improve symptoms
- Post-surgical rehabilitation involving immobilization for 4-6 weeks followed by progressive physical therapy for 3-6 months It is also important to consider the factors that can affect the outcome of rotator cuff surgery, such as increasing patient age, MRI tear characteristics, and workers’ compensation status, as these can correlate with less favorable outcomes 1. Additionally, the use of perioperative subacromial corticosteroid injections or NSAIDs is not recommended for or against, as the evidence is inconclusive 1. Overall, the goal of treatment is to prevent tear progression, muscle atrophy, and fatty infiltration, and to improve functional outcomes and quality of life for patients with full thickness tears in the supraspinatus tendon.
From the Research
Treatment Approaches for Full Thickness Tear in the Supraspinatus Tendon
- The treatment approach for a full thickness tear in the supraspinatus tendon near its footprint can vary depending on several factors, including the size and location of the tear, as well as the patient's age and overall health 2, 3, 4.
- A study published in the Journal of Biomechanics found that the location and size of the tear can significantly impact the risk of propagation, with anterior tears being at greater risk of propagating than central or posterior tears 2.
- Another study published in The Bone & Joint Journal found that operative treatment is no better than conservative treatment for non-traumatic supraspinatus tears, and that conservative treatment should be considered as the primary method of treatment for this condition 3.
- Arthroscopic repair of full-thickness supraspinatus tears has been shown to be an effective treatment option, with good functional results and a high rate of tendon-to-bone healing 4, 5.
- A study published in Arthroscopy found that arthroscopic in situ repair of partial-thickness rotator cuff tears produces excellent functional outcomes in more than 80% of patients, and revision rates are low 5.
- However, a study published in The American Journal of Sports Medicine found that the repaired supraspinatus tendon was significantly thinner and the corresponding acromiohumeral distance was reduced one year after rotator cuff surgery, and that early initiation of tendon-loading exercises did not affect these findings 6.
Factors Affecting Treatment Outcomes
- Patient age and overall health can impact treatment outcomes, with older patients being at greater risk of tendon retear and poorer functional outcomes 4, 6.
- The size and location of the tear can also impact treatment outcomes, with larger tears and those located in the anterior region being at greater risk of propagation and poorer functional outcomes 2, 4.
- The presence of associated injuries, such as delamination of the subscapularis or infraspinatus tendon, can also impact treatment outcomes and reduce the likelihood of tendon healing 4.