What is the treatment for a full thickness full width supraspinatus tear with diffusely thinned and partially torn infraspinatus tendons?

Treatment for Full Thickness Full Width Supraspinatus Tear with Diffusely Thinned and Partially Torn Infraspinatus Tendons

Surgical repair is the recommended treatment for a full thickness full width supraspinatus tear with diffusely thinned and partially torn infraspinatus tendons, with options including complete repair, partial repair, or muscle transfers depending on tear reparability. 1

Initial Assessment

Before determining the specific surgical approach, proper evaluation is necessary:

• Imaging studies: MRI or ultrasound should be performed to fully characterize the tear pattern and assess:

  • Extent of supraspinatus tear (full thickness, full width)
  • Degree of tendon retraction
  • Muscle atrophy and fatty infiltration
  • Status of infraspinatus partial tears 1

• Key factors affecting treatment decision:

  • Patient age and activity level
  • Chronicity of tear
  • Degree of tendon retraction
  • Quality of remaining tissue
  • Presence of fatty infiltration in the rotator cuff muscles

Treatment Algorithm

1. For Reparable Tears:

Primary approach: Complete surgical repair of both the supraspinatus and infraspinatus tendons

• Surgical technique options:

  • Arthroscopic repair
  • Mini-open repair
  • Open repair

  Note: Current evidence does not support superiority of one technique over another 1

• Repair considerations:

  • Attempt to achieve tendon-to-bone healing of the cuff 1
  • Address both the supraspinatus full-thickness tear and the partially torn infraspinatus
  • Consider linked double-row repairs for most full-thickness tears 2
  • For the infraspinatus partial tears, thorough treatment (curettage-closure of delamination tears) is recommended 3

2. For Irreparable Tears:

When complete repair is not possible due to tissue quality, retraction, or fatty infiltration:

• Option A: Partial rotator cuff repair of whatever portion can be repaired 1
• Option B: Debridement with or without biceps tendon release 1
• Option C: Muscle transfers (latissimus dorsi or teres major) for irreparable tears involving both supraspinatus and infraspinatus 1

Expected Outcomes

• Complete repair: Excellent clinical outcomes with high patient satisfaction can be expected 4
• Partial repair: Improvement in pain and function even when complete repair cannot be achieved 1
• Muscle transfers: Improvement in pain and function, though complications may include temporary complex regional pain syndrome and cosmetic deformity 1

Important Considerations

• Avoid non-cross-linked porcine small intestine submucosal xenograft patches as they have shown less favorable outcomes and higher complication rates (20-30% hypersensitivity reactions) 1

• Acromioplasty is not required during rotator cuff repair for normal acromial bone (including type II and III morphology), as studies show it has little to no effect on postoperative clinical outcomes 1

• Addressing partial infraspinatus tears during supraspinatus repair is important, as research suggests that proper treatment of adjacent partial tears leads to optimal functional and anatomical outcomes 3

• Monitoring for retears is important, as functional outcomes tend to worsen when retears occur in cases with partial tears of adjacent tendons 3

Surgical Technique Pearls

• For the supraspinatus full-thickness tear:

  • Single-row repair may be used for small tears
  • Double-row repair is preferred for most other cases 2

• For the partially torn infraspinatus:

  • Curettage-closure technique for delamination tears 3
  • Side-to-side repair techniques may be beneficial 5

• Completion of high-grade partial thickness tears to full-thickness tears before repair has shown lower retear rates compared to primary repair of full-thickness tears 6

By following this treatment algorithm and addressing both the full-thickness supraspinatus tear and the partially torn infraspinatus tendons, optimal functional and anatomical outcomes can be achieved.