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Rotator cuff imaging using bursography coupled to helical computed arthrotomography.

OBJECTIVE: To describe a rotator cuff imaging method with high sensitivity for the detection of partial tears of the superficial surface of the rotator cuff. PATIENTS AND METHODS: 33 patients with shoulder pain and no conventional arthrography evidence of a full-thickness rotator cuff tear were investigated by bursography coupled with helical computed arthrotomography. Nine subsequently underwent surgery or bursoscopy. RESULTS: Helical computed arthrotomography disclosed an abnormality of the superficial surface of the rotator cuff in 15 patients (45.5%). In the nine patients who had surgery or bursoscopy, findings from this investigation were consistent with those from bursography plus helical computed tomography. CONCLUSION: Bursography coupled with helical computed tomography may be of assistance for the diagnosis of lesions of the superficial cuff surface, which often escape detection by ultrasonography and magnetic resonance imaging.

Bursa, Synovial↗

Repair of full thickness rotator cuff tears. Gender, age, and other factors affecting outcome.

Seventy-two full thickness rotator cuff tears (72 patients) were treated with an open rotator cuff repair between 1986 and 1993. The average postoperative followup was 54 months (range, 24-102 months; standard deviation, 22 months). Fifty-three (74%) patients had no pain, 16 (22%) patients had slight pain without restriction of activities, and three (4%) patients had moderate pain with activity compromise. Women with an associated biceps tendon rupture tended to have worse results. Women had a negative, statistically significant relationship between age and shoulder scoring scales, but age at the time of surgery was not related to any outcome variables for men. A rotator cuff tear greater than or equal to 5 cm2 as determined at the time of surgery was associated with a poorer outcome. The average University of California at Los Angeles score was 32 points (range, 7-35 points; standard deviation, 5 points). The average Constant-Murley score was 78 of 100 points (range, 12-95 points; standard deviation, 15 points). A yes response was given for an average of 10 of 12 questions on the Simple Shoulder Test (range, 0-12 questions; standard deviation, 3 questions). More than 4 years after open rotator cuff repair, patients had a 94% patient satisfaction rate with lasting relief of pain and improved function.

Adult↗

Tendon transfers for the treatment of irreparable rotator cuff defects.

Certain defects of the rotator cuff musculotendinous units cannot be repaired. If restoration of strength is an important treatment goal, then tendon transfers must be considered for palliation. In this article, the anatomical and physiological bases for tendon transfers are discussed, and currently known results with this form of treatment are reviewed.

Humans↗

Salvage rotator cuff repair using a biotenodesis screw.

Rotator cuff tear fixation can be difficult when humeral head bone stock is poor as a result of osteopenia or osteoporosis. This technical note describes biotenodesis screw use to achieve effective fixation after 2 previous attempts at implanting suture anchors failed.

Bone Screws↗

Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial.

BACKGROUND: Evidence to justify the use of porcine small intestine submucosa to augment repairs of large and massive rotator cuff tears is based on favorable results found in studies of Achilles tendon and infraspinatus tendon repairs in canines. The purpose of this study was to determine the effectiveness of a small intestine submucosal patch to augment the repair of chronic two-tendon rotator cuff tears in humans. METHODS: Thirty shoulders with a chronic two-tendon rotator cuff tear that was completely repairable with open surgery were randomized to be treated with either augmentation with porcine small intestine mucosa or no augmentation. All patients completed a PENN shoulder-score questionnaire preoperatively and at the time of the latest follow-up (at an average of fourteen months). Magnetic resonance imaging showed that nine shoulders had a large tear and twenty-one had a massive tear. All patients underwent a magnetic resonance imaging scan with intra-articular gadolinium one year after the repair to assess the status of the rotator cuff. RESULTS: The rotator cuff healed in four of the fifteen shoulders in the augmentation group compared with nine of the fifteen in the control group (p = 0.11). The median postoperative PENN total score was 83 points in the augmentation group compared with 91 points in the control group (p = 0.07). Healing of the defects in both groups demonstrated a strong correlation with the patients' clinical scores. The median postoperative PENN total score was 96 points in the group with a healed repair and 81 points in the group with a failed repair (p = 0.007). The percentage change between the preoperative and postoperative patient satisfaction scores was 400% in the group with a healed repair, and 50% in the group with a failed repair (p = 0.04). CONCLUSIONS: Augmentation of the surgical repair of large and massive chronic rotator cuff tears with porcine small intestine submucosa did not improve the rate of tendon-healing or the clinical outcome scores. On the basis of these data, we do not recommend using porcine small intestine submucosa to augment repairs of massive chronic rotator cuff tears done with the surgical and postoperative procedures described in this study.

Adult↗

[Comparison between T2*- and T2-weighted images in diagnosing rotator cuff tears].

This study was performed to determine the merits of T2*-weighted images in diagnosing rotator cuff tear, compared with T2-weighted images. T2-and T2*-weighted images were obtained in 10 asymptomatic volunteers and 94 patients with symptoms referable to the rotator cuff. The increased signal with full thickness of the rotator cuff was not shown on either T2- or T2*-weighted images in the volunteers. These findings on T2-weighted images and on T2*-weighted images were observed in 33 and 58 of 94 patients with symptoms, respectively. Every patient who showed these abnormal findings on T2-weighted images had the abnormal findings on T2*-weighted images. These findings on T2*-weighted images were wider than those on T2-weighted images in 20 of 33 patients. Surgical findings were available in 21 of 94 patients. Rotator cuff tears were surgically confirmed in 20 patients whose MR images showed increased signal lesions on both T2- and T2*-weighted images. On the other hand, one patient who did not have rotator cuff tear showed increased signal lesion with full thickness on T2*-weighted images, but not on T2-weighted images. We think increased signal lesions on T2-weighted images may strongly suggest rotator cuff tear, whereas those on T2*-weighted images are not specific.

Adolescent↗

Pullout strength of suture anchors used in rotator cuff repair.

BACKGROUND: Surgical treatment of rotator cuff tears may be complicated by osteoporosis of the proximal part of the humerus. The purpose of this study was to determine whether pullout strength of suture anchors is affected by the location of the anchor placement and by bone mineral density. We hypothesized that higher bone mineral density is associated with higher pullout strength of suture anchors. METHODS: Peripheral quantitative computed tomography was used to measure total, trabecular, and cortical bone mineral density in different regions of the lesser and greater tuberosities in seventeen cadaveric humeri. Suture anchors were inserted into individual regions and subjected to cyclic loading. Repeated-measures analysis of variance was used to assess differences in bone mineral density and load to failure between regions of interest. Pearson correlation was used to determine the association between bone mineral density and pullout strength of suture anchors. RESULTS: Total, trabecular, and cortical bone mineral densities were an average of 50%, 50%, and 10% higher, respectively, in the proximal part of the tuberosities compared with the distal part (p < 0.01). Within the proximal part of the greater tuberosity, trabecular bone mineral density of the posterior region and cortical bone mineral density of the middle region were, on the average, 25% and 16% higher, respectively, than the densities in the other regions (p < 0.01). Load to failure in the proximal part of the tuberosities was an average of 53% higher than that in the distal part (p < 0.01). The lesser tuberosity showed, on the average, a 32% higher load to failure than did the greater tuberosity (p < 0.01). Within the proximal part of the greater tuberosity, loads to failure in the anterior and middle regions were, on the average, 62% higher than the load to failure in the posterior region (p < 0.01). Overall positive correlations were found between bone mineral density and load to failure (0.65 </= r </= 0.74, p < 0.01). CONCLUSIONS: We found that pullout strength of suture anchors correlates well with bone mineral density of the tuberosities. Higher loads to failure were found in regions in the proximal part of the tuberosities. Placement of anchors in these regions may prevent anchor loosening, formation of a tendon-bone gap, and failure of the rotator cuff repair.

Aged↗

The new subclavian portal and modified Neviaser portal for arthroscopic rotator cuff repair.

Shoulder arthroscopy and the introduction of suture anchors has provided the surgeon with the ability to repair rotator cuff tears through minimal incisions. Rotator cuff repair involves the use of several portals, such as the posterior portal, the anterior portal, the anterior superior portal, the anterior inferior portal, and the Neviaser portal. The authors have developed 2 additional portals, the new Subclavian portal and the modified Neviaser portal, to improve the safety and efficacy of rotator cuff repair and solve a number of problems associated with traditional repair techniques. The subclavian portal is located directly below the clavicle, 1 to 2 cm from the acromioclavicular joint, and instruments are aimed medial to lateral. The modified Neviaser portal changes the angle of insertion of the Neviaser portal. Instruments are aimed 20 degrees from the horizontal plane and 45 degrees anterior, directly at the suture anchor. Repair techniques using each portal were reviewed. Twenty cadaveric shoulders were dissected for each portal and the anatomy from each portal was documented. The cadaveric dissections showed that this portal passes greater than 6 cm from the brachial plexus, musculocutaneous nerve, and subclavian artery and vein, and 4.7 cm from the cephalic vein. The modified Neviaser portal was shown to be safer than the Neviaser portal because it passes on top of the supraspinatous muscle, thereby protecting the suprascapular nerve. These portals provide an optimal angle of approach to the rotator cuff tendon and suture anchor as well as improved safety and efficacy in the repair of rotator cuff tears.

Aged↗

MR imaging of rotator cuff tears in individuals with paraplegia.

OBJECTIVE: The purpose of this study was to use MR imaging to evaluate the prevalence and extent of rotator cuff tears in paraplegic patients, who are at increased risk for impingement caused by overuse. MATERIALS AND METHODS: Sixty-four MR examinations of the shoulder were evaluated for partial or full-thickness rotator cuff tears and for single or multiple rotator cuff tendon tears. Thirty-seven MR studies were from paraplegic subjects (26 symptomatic, 11 asymptomatic), and 27 MR studies were from able-bodied subjects (17 symptomatic, 10 asymptomatic). RESULTS: Among subjects who were symptomatic and paraplegic, 73% of shoulders imaged showed evidence of rotator cuff tear on MR images compared with 59% of shoulders in able-bodied symptomatic subjects. Of all subjects with paraplegia, 57% of shoulders imaged showed rotator cuff tears. Among all paraplegic subjects, prevalence and severity of tears correlated positively with age and duration of spinal cord injury. Tears that involved the posterior portion of the rotator cuff were revealed on MR images in 74% of the paraplegic subjects compared with 50% of the able-bodied subjects. CONCLUSION: MR imaging revealed a high percentage and degree of severity of rotator cuff tears in individuals with paraplegia and thus proved useful in evaluating shoulders in these patients.

Adult↗

[The results of arthroscopic repair of full-thickness tears of the rotator cuff].

OBJECTIVES: This study was designed to evaluate the functional results of arthroscopic repair of full-thickness tears of the rotator cuff and to investigate the degree of fatty degeneration of the rotator cuff muscles and recurrent ruptures by magnetic resonance imaging (MRI). METHODS: Twenty-two patients (9 males, 13 females; mean age 56 years; range 38 to 71 years) underwent arthroscopic repair of full-thickness tears of the rotator cuff following conservative treatment for a mean of 15 months (range 45 days to 120 months). Involvement was in the right shoulder in 17 patients, being on the dominant side in 77%. The range of motion was measured with a goniometer, and muscle strength by manual examination. Clinical and functional evaluations were made by physical examination and according to the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and the UCLA scale. Fatty degeneration of the rotator cuff muscles and recurrence were analyzed by MRI. The mean follow-up was 24 months (range 12 to 36 months). RESULTS: The mean active forward flexion and external rotation increased from 105 degrees to 160 degrees (p<0.05) and from 41 degrees to 44 degrees (p>0.05), respectively. The strength of the supraspinatus and infraspinatus muscles significantly increased (p<0.05). The mean ASES and UCLA scores significantly increased from 25.4 to 86.7 and from 10.6 to 25.6, respectively (p<0.05). The mean healing time was three months (range 1 to 12 months). Twenty patients (90.9%) were satisfied with the result of the treatment. On MRI scans, recurrent ruptures were detected in seven patients (31.8%); the extent of fatty degeneration of the rotator cuff muscles did not differ pre- and postoperatively (p>0.05). CONCLUSION: Arthroscopic repair of full-thickness tears of the rotator cuff yields high clinical and functional success rates.

Adult↗

Descriptive report of shoulder range of motion and rotational strength 6 and 12 weeks following rotator cuff repair using a mini-open deltoid splitting technique.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To measure short-term postsurgery glenohumeral internal rotation and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following mini-open rotator cuff repair of full-thickness rotator cuff tears. BACKGROUND: Physical therapists provide rehabilitation for patients following mini-open rotator cuff repair. Long-term outcome studies have reported a high percentage of good and excellent results following surgery; however, little has been published regarding the immediate short-term results of this procedure, during which the patient is under the direct care of the physical therapist. MATERIALS AND METHODS: Charts from 11 female and 26 male patients, with a mean +/- SD age of 57.3 +/- 9.9 years, were reviewed following rotator cuff repair, using an arthroscopically assisted mini-open deltoid-splitting approach. All patients underwent postsurgery rehabilitation by the same therapist using a standard protocol. Retrospective chart review was used to obtain descriptive profiles of shoulder joint ROM at 6 and 12 weeks postsurgery and isokinetically assessed shoulder strength at 12 weeks postsurgery. RESULTS: For the postsurgical shoulder, ROM deficits ranging between 5 degrees to 7 degrees were measured for shoulder abduction and external rotation and internal rotation at 90 degrees of abduction. The postsurgical extremity had greater flexion ROM (9 degrees ) compared to the contralateral side. Isokinetic external rotation strength deficits of 5% to 7% were present at 12 weeks postsurgery, with 2% to 11% greater internal rotation shoulder strength on the operative extremity, when compared to the other side. Patients completed the self-report section of the modified American Shoulder Elbow Surgeons (ASES) Rating Scale at 12 weeks postsurgery and scored a mean of 38.7/45.0 points. CONCLUSION: The application of early ROM and progressive strengthening following mini-open rotator cuff repair allows for the successful return of ROM and strength 12 weeks postsurgery. The results of this study provide objective data for both shoulder ROM and strength at time points during which patients are traditionally receiving physical therapy following surgery.

Aged↗

Arthroscopic subacromial decompression: results according to the degree of rotator cuff tear.

We evaluated the results of arthroscopic subacromial decompression according to the degree of rotator cuff tear in 71 patients, available for follow-up for at least 1 year (average 19 months). Of the patients with stage II disease, 82% were satisfied regardless of whether they had no rotator cuff tear (nine of 11) or had a partial tear (28 of 34) of the rotator cuff. Of patients with stage III disease (complete rotator cuff tear), 88% (23 of 26) were satisfied. An acceptable objective UCLA shoulder rating greater than or equal to 28 points was seen in 82% (nine of 11) of the patients without a rotator cuff tear, 76% (26 of 34) with a partial tear, and 77% (20 of 26) with a complete tear. All four of the patients with complete tears less than 1 cm obtained excellent results. Three of the six failures were in patients with complete tears who had a narrowed acromial-humeral distance of less than 7 mm. The average UCLA pain score showed significant improvement from 2.8 (constant pain) to 8.6 (occasional pain) at 1-2 years postoperatively. The function, strength, and active forward flexion scores also increased at 1-2 years from their preoperative values. The overall patient satisfaction rate of 85% and the objective success rate of 77% are within the range of that seen with open rotator cuff repair.

Arthroscopy↗

MR diagnosis of rotator cuff tears of the shoulder: value of using T2-weighted fat-saturated images.

OBJECTIVE: The purpose of this study was to compare the use of fat-saturated T2-weighted spin-echo MR imaging with that of conventional T2-weighted spin-echo MR imaging to detect full- and partial-thickness tears of the rotator cuff of the shoulder, using arthroscopy as the standard for the diagnosis. SUBJECTS AND METHODS: Forty-nine consecutive patients with shoulder pain who had both MR imaging and arthroscopy of their affected shoulders were studied. The study group consisted of 10 patients with full-thickness tears of the rotator cuff, 20 with partial-thickness tears of the rotator cuff, and 19 with intact rotator cuff tendons proved arthroscopically. All patients had T1-weighted, conventional T2-weighted, and fat-saturated T2-weighted MR images obtained in a plane slightly oblique to the coronal plane along the long axis of the supraspinous tendon. The images were divided into two sets, one including both T1-weighted and conventional T2-weighted images, the other including T1-weighted and fat-saturated T2-weighted images. Two musculoskeletal radiologists reviewed each set of MR images in a blinded fashion. The reviewers were asked to decide whether the rotator cuff showed a full-thickness tear, a partial-thickness tear, or no tear on each set of images. In the case of partial-thickness tears, the reviewers were asked to indicate which surface (bursal or joint) of the rotator cuff was affected. These data were correlated with the arthroscopic findings and with each other using McNemar and kappa analysis. RESULTS: Detection of full-thickness tears was excellent for both reviewers using either imaging technique. However, when the fat-saturated technique was used, the sensitivity increased significantly, from 80% to 100%. Detection of partial-thickness tears was poor with conventional spin-echo MR imaging (15%). Although significantly improved when fat saturation was used (35%), detection rates were still lower than rates reported in the literature. Identification of the torn surface of the rotator cuff was correct in 50% of cases in which partial-thickness tears were successfully identified. Fat saturation decreased the specificity of identification of both partial and full-thickness tears of the rotator cuff but significantly increased the specificity with which intact rotator cuffs were identified. CONCLUSION: Use of the fat-saturation technique improved detection of both full-thickness and partial-thickness tears of the rotator cuff on MR images compared with standard spin-echo imaging techniques. Despite this improvement, detection of partial-thickness tears was poor with both techniques. Furthermore, correct identification of which surface of the rotator cuff was torn in patients with partial tears was nearly random.

Adult↗

Increased substance P in subacromial bursa and shoulder pain in rotator cuff diseases.

The subacromial bursa is recognized as a site associated with the shoulder pain caused by rotator cuff disease in the middle-aged and elderly. Substance P is contained in primary afferent nerves, and its quantity increases during chronic pain. The amount of substance P in the subacromial bursa of patients with rotator cuff disease was examined. Radioimmunoassay and immunohistochemistry were employed to quantify and localize substance P. The preoperative pain level was measured with a visual analogue scale with 0 as no pain, 5 as moderate, and 10 as severe. Thirty-seven patients that had undergone operation were divided into two groups: one composed of 19 patients with subacromial bursitis and a partial-thickness tear of the rotator cuff (nonperforated cuff) and the other composed of 18 patients with a full-thickness tear (perforated cuff). Subacromial bursae obtained from seven fresh cadavers with no shoulder pain before death were used as controls. The visual analogue scale showed significantly greater pain in the group with the nonperforated rotator cuff than in the group with the perforated cuff. Consistent with these results, the amount of substance P in the subacromial bursa was significantly greater in the former group than in the latter. Nerve fibers immunoreactive to substance P were localized around the vessels, with a larger number of fibers in the group with the nonperforated rotator cuff. Therefore, an increased amount of substance P in the subacromial bursa appears to correlate with the pain caused by rotator cuff disease.

Adult↗

Rotator cuff repair tension as a determinant of functional outcome.

This study evaluated the effect of rotator cuff repair tension on surgical outcome. A total of 67 consecutive rotator cuff repairs for full-thickness tendon tears were prospectively evaluated. Rotator cuff repair tension was quantified by means of an intraoperative calibrated tensiometer after cyclic loading. The point of maximum repair tension was measured. Patients were evaluated for pain and improvement before and after surgery through use of Constant scores, American Shoulder and Elbow Surgeons' functional criteria, isokinetic strength-testing, and visual analog scale scores. Increased repair tension correlated with lesser gains in postoperative Constant score, a decrease in perceived improvement, decreased isokinetic strength measurements, and increased pain. Tension on repaired rotator cuff tendons should be minimized. High-tension repairs--those greater than 8 lb--are associated with poor subjective and objective outcomes and are not recommended.

Adult↗

Biomechanical analysis of tendon transfers for massive rotator cuff tears.

OBJECTIVE: To determine why certain tendon transfers are mechanically more effective than other tendon transfers for the treatment of a massive rotator cuff tear. DESIGN: A tendon transfer procedure of latissimus dorsi, teres major or a combination of these two to the insertions of either teres minor, infraspinatus, supraspinatus, or subscapularis is simulated using a biomechanical musculoskeletal model of the upper extremity. BACKGROUND: Massive rotator cuff tears are not easily repaired. To compensate for the loss of rotator cuff function, techniques such as muscle transfers are developed. METHODS: Three range of motion tasks were used as input to the Delft shoulder and elbow model. The muscle parameters of the Delft shoulder and elbow model were modified to simulate a rotator cuff tear. A biomechanical analysis of the transferred muscles was performed, taking outcome variables such as moment arms, muscle length and muscle force into account. RESULTS: Due to the massive rotator cuff tear, an elevation and external rotation moment is lost. When the tendon was transferred to the insertions of infraspinatus or supraspinatus, the humerus was capable of elevating and externally rotating. CONCLUSIONS: On the basis of mechanical parameters such as moment arms, muscle length and force it can be concluded that a tendon transfer of the teres major to the supraspinatus insertion will produce the best functional outcome in the treatment of massive rotator cuff tears. RELEVANCE: To find biomechanical evidence for an optimal tendon transfer that will lead to improved treatment of patients with a massive rotator cuff tear.

Biomechanical Phenomena↗

Variation in orthopaedic surgeons' perceptions about the indications for rotator cuff surgery.

BACKGROUND: Epidemiologic studies have demonstrated substantial variations in per capita rates of many surgical procedures, including rotator cuff repair. The purpose of the current study was to characterize orthopaedic surgeons' attitudes concerning medical decision-making about rotator cuff surgery and to investigate the associations between these beliefs and reported surgical volumes. METHODS: A survey was mailed to randomly selected orthopaedic surgeons listed in the American Academy of Orthopaedic Surgeons directory. Only individuals who had treated patients for a rotator cuff tear, or had referred patients for such treatment, within the previous year were asked to complete the two-page survey. The survey comprised fifteen questions regarding clinical opinion, including four regarding hypothetical cases. Clinical agreement was defined as >80% of the respondents answering similarly. RESULTS: Of the 1100 surveys that were mailed, 539 were returned (a response rate of 49%). Of the 539 respondents, 316 (58.6%) had treated or referred patients with a rotator cuff tear in the previous year. There was a significant negative correlation between the surgeon's estimation of the failure rate of cuff repairs in the United States and that surgeon's procedure volume (r = -0.21, p = 0.0003), indicating that surgeons with a lower procedure volume are more pessimistic about the results of surgery than are those with a higher procedure volume. Arthroscopic, mini-open, and open cuff repairs were preferred by 14.5%, 46.2%, and 36.6% of the respondents, respectively. Surgeons who performed a higher volume of procedures were less likely to perform open surgery (p < 0.0001). There was clinical agreement regarding only four of the nine clinical questions and none of the four questions about the hypothetical vignettes. CONCLUSIONS: We found significant variation in surgical decision-making and a lack of clinical agreement among orthopaedic surgeons about rotator cuff surgery. There was a positive correlation between the volume of procedures performed by the surgeon and the surgeon's perception of outcome, with surgeons who had a higher procedure volume being more enthusiastic about rotator cuff surgery than those who had a lower procedure volume.

Analysis of Variance↗

[The results of arthroscopic repair in partial rotator cuff tears].

OBJECTIVES: We evaluated patients who underwent arthroscopic repair for partial rotator cuff tears less than 50% of tendon thickness with respect to the course of tears and functional results. METHODS: Nineteen patients (10 women, 9 men; mean age 49 years; range 40 to 70 years) who did not benefit from conservative treatment for partial rotator cuff tears were treated with arthroscopic debridement with or without subacromial decompression. Twelve patients had a history of trauma before the appearance of complaints which had a mean duration of 12 months (range 7 to 24 months) before arthroscopic repair. Partial tears were on the articular side in 12 patients, and on the bursal side in seven patients. The patients were assessed with preoperative and postoperative physical examination, magnetic resonance imaging (MRI), and UCLA scores. RESULTS: The mean preoperative and postoperative UCLA scores were 16.8 (range 10 to 20) and 29.0 (range 9 to 35), respectively (p<0.05). The results were excellent or good in 14 patients (73.7%), fair in two patients (10.5%), and poor in three patients (15.8%). One patient developed shoulder stiffness which improved following rehabilitation. Postoperative MRI showed persistence of partial tears in 13 patients, progression in five patients, and development of total rupture in one patient. Complaints of pain increased in severity in patients in whom partial tears manifested a progressive course. One patient with total rupture underwent mini-open rotator cuff repair in the postoperative sixth month. CONCLUSION: Although clinical symptoms show improvement in most of the patients following arthroscopic treatment, partial rotator cuff tears do not heal completely in a considerable number of cases, and may progress to full-thickness tears in some.

Acromion↗