N.N. Priorov Journal of Traumatology and OrthopedicsN.N. Priorov Journal of Traumatology and OrthopedicsВестник травматологии и ортопедии им. Н.Н. Приорова0869-86782658-6738Eco-Vector63514410.17816/vto635144RNOTMBReviewsОбзорыReview ArticlePartial-thickness rotator cuff tears: a systematic reviewНеполнослойные разрывы вращательной манжеты: систематический обзор литературыhttps://orcid.org/0009-0008-9147-58083852-2953AvdeevArtem K.АвдеевАртём Константинович
Russian Federation

MD

avdeev.artiom@mail.ruhttps://orcid.org/0009-0000-3886-163X7085-8861GoferAnton S.ГоферАнтон Сергеевич
Russian Federation

MD

a.hofer.ortho@gmail.comhttps://orcid.org/0000-0003-3264-81463819-0982AlekperovAleksandr A.АлекперовАлександр Александрович
Russian Federation

MD

alecperov@mail.ruhttps://orcid.org/0009-0007-1490-97832863-2017RubtsovDmitriy V.РубцовДмитрий Вячеславович
Russian Federation

MD

rubic.dv@yandex.ruhttps://orcid.org/0000-0002-8997-73307596-2960PavlovVitaliy V.ПавловВиталий Викторович
Russian Federation

MD, Dr. Sci. (Medicine)

д-р мед. наук

rubic.dv@yandex.ruTsivyan Novosibirsk Research Institute of Traumatology and OrthopaedicsНовосибирский научно-исследовательский институт травматологии и ортопедии им. Я.Л. Цивьяна21062025220720253225075191308202428102024Copyright ©; 2025, Eco-VectorCopyright ©; 2025, Эко-Вектор2025Eco-VectorЭко-Векторhttps://eco-vector.com/for_authors.php#07https://journals.eco-vector.com/0869-8678/article/view/635144

Partial-thickness tears of the rotator cuff (RC) of the shoulder joint (SJ) are a common condition that causes pain and limits SJ function, significantly reducing quality of life. The prevalence of such tears reaches up to 32% among SJ injuries and disorders. Among all isolated RC tendon injuries, supraspinatus tendon lesions are predominant, accounting for up to 13%. This work aimed to conduct a systematic review of research assessing radiographic parameters of SJ bone anatomy as risk factors for RC injury, as well as the outcomes of surgical treatment for partial-thickness RC tears. A search was conducted in the eLIBRARY, PubMed, and Scopus databases. The search depth was 10 years (2013–2023). The inclusion criteria for the quantitative analysis were a mean follow-up duration of at least 6 months and a minimum of 10 cases per study. Following a keyword-based screening, 18 publications were included in the quantitative analysis. The most significant radiographic risk factors for RC tears included the critical shoulder angle (CSA), lateral acromial angle (LAA), and acromial index (AI). Two principal surgical techniques for managing Ellman grade III partial-thickness RC tears were identified: tear completion and transtendinous tendon repair. Both techniques yielded satisfactory outcomes; however, it remains unclear which method should be preferred. Although the majority of studies report a direct association between CSA and RC injury, this parameter requires further investigation, as angular values obtained from radiographs without adherence to the Suter–Henninger protocol may differ significantly from those obtained in accordance with the protocol, as well as from CT or MRI findings. The majority of publications did not consider parameters like LAA and AI to be key predictors of RC injury. The analyzed outcomes of surgical treatment for partial-thickness RC tears showed no significant differences despite the use of different surgical techniques, such as tear completion and transtendinous tendon repair. However, this issue requires further investigation, including subsequent assessment of tendon healing quality based on MRI findings.

Неполнослойные разрывы вращательной манжеты (ВМ) плечевого сустава (ПС) — распространённая патология, являющаяся причиной боли, которая приводит к ограничению функции ПС, снижая качество жизни пациентов, с частотой встречаемости до 32% среди травм и заболеваний ПС. Среди всех изолированных повреждений сухожилий ротаторной манжеты доминирующую роль играют повреждения сухожилия надостной мышцы, достигая 13%. Цель данной работы — выполнить систематический обзор исследований, оценивающих рентгенологические параметры костной анатомии ПС как фактора риска повреждения ВМ и результаты хирургического лечения неполнослойных разрывов ВМ. Проведён информационный поиск в базах данных eLIBRARY, PubMed и Scopus. Глубина поиска — 10 лет (с 2013 по 2023 г.). Критерии включения в количественный анализ: средний срок наблюдения пациентов не менее 6 мес., количество наблюдений не менее 10 случаев. После оценки статей по ключевым словам в количественный анализ включили 18 публикаций. Среди основных рентгенологических факторов риска повреждения ВМ — критический угол плеча (CSA), латеральный угол акромиона (LAA), акромиальный индекс (AI). Выявлены две основные методики по устранению разрыва ВМ 3-й степени по Ellman: метод завершения разрыва и транстендинозная пластика сухожилия. Оба метода демонстрируют удовлетворительные результаты, однако не ясно, какому из них стоит отдать предпочтение. Несмотря на то, что большая часть исследований сообщает о наличии прямой взаимосвязи CSA с повреждениями ВМ, данный параметр нуждается в дальнейшем исследовании, так как угловые значения, полученные на рентгенограммах без соблюдения протокола Сутера–Хеннингера, могут значительно отличаться от данных, полученных при его соблюдении, а также от данных КТ- или МРТ-исследования. В основной части публикаций исследованные параметры, такие как LAA и AI, не явились ключевыми предикторами повреждений ВМ. Проанализированные результаты хирургического лечения неполнослойных разрывов ВМ показали, что, несмотря на различные хирургические техники, а именно технику завершения разрыва и транстендинозную пластику сухожилия, различий в клинических исходах не отмечено. Однако данный факт нуждается в дополнительном исследовании с последующей оценкой качества восстановления сухожилия по МРТ.

partial-thickness rotator cuff tearsupraspinatus tendon injuryacromial morphologysuprascapular nerve neuropathysuprascapular nerve decompressionнеполнослойные разрывы вращательной манжетыповреждение надостной мышцыморфология акромионанейропатия надлопаточного нервадекомпрессия надлопаточного нерваFukuda H. Partial-thickness rotator cuff tears: a modern view on Codman’s classic. J Shoulder Elbow Surg. 2000;9(2):163–8.Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77(1):10–5. doi: 10.2106/00004623-199501000-00002Yamanaka K. Pathological study of the supraspinatus tendon. Nihon Seikeigeka Gakkai Zasshi. 1988;62(12):1121–38. (in Japanese).Kamijo H, Sugaya H, Takahashi N, et al. Arthroscopic Repair of Isolated Subscapularis Tears Show Clinical and Structural Outcome Better for Small Tears Than Larger Tears. Arthrosc Sports Med Rehabil. 2022 May;4(3):e1133–e1139. doi: 10.1016/j.asmr.2022.04.006Melis B, DeFranco MJ, Lädermann A, Barthelemy R, Walch G. The teres minor muscle in rotator cuff tendon tears. Skeletal Radiol. 2011;40(10):1335–44. doi: 10.1007/s00256-011-1178-3Fitzpatrick S, Reynolds AW, Purnell G. Arthroscopic Repair of an Isolated Infraspinatus Tear in a Contact Athlete: A Case Report. J Orthop Case Rep. 2019;9(3):7–10. doi: 10.13107/jocr.2250-0685.1394Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res. 1990;(254):64–74.Snyder SJ, Pachelli AF, Del Pizzo W, et al. Partial thickness rotator cuff tears: results of arthroscopic treatment. Arthroscopy. 1991;7(1):1–7. doi: 10.1016/0749-8063(91)90070-eZhao J, Luo M, Liang G, et al. What Factors Are Associated with Symptomatic Rotator Cuff Tears: A Meta-analysis. Clin Orthop Relat Res. 2022;480(1):96–105. doi: 10.1097/CORR.0000000000001949Ayanoglu T, Ozer M, Cetinkaya M, et al. Does Preoperative Conservative Management Affect the Success of Arthroscopic Repair of Partial Rotator Cuff Tear? Indian J Orthop. 2021;56(2):289–294. doi: 10.1007/s43465-021-00479-2Matthewson G, Beach CJ, Nelson AA, et al. Partial Thickness Rotator Cuff Tears: Current Concepts. Adv Orthop. 2015;2015:458786. doi: 10.1155/2015/458786Thangarajah T, Lo IK. Optimal Management of Partial Thickness Rotator Cuff Tears: Clinical Considerations and Practical Management. Orthop Res Rev. 2022;14:59–70. doi: 10.2147/ORR.S348726Brockmeyer M, Haupert A, Lausch AL, et al. Outcomes and Tendon Integrity After Arthroscopic Treatment for Articular-Sided Partial-Thickness Tears of the Supraspinatus Tendon: Results at Minimum 2-Year Follow-Up. Orthop J Sports Med. 2021;9(2):2325967120985106. doi: 10.1177/2325967120985106Leong YC, Yeoh CW, Azman MI, Juhari MS, Siti HT. Acromion Morphology of Patients with Rotator Cuff Disease in Standard AP Shoulder Radiograph in Hospital Sultanah Bahiyah and Hospital Kuala Lumpur. Malays Orthop J. 2022;16(3):50–54. doi: 10.5704/MOJ.2211.009Kim MS, Rhee SM, Jeon HJ, Rhee YG. Anteroposterior and Lateral Coverage of the Acromion: Prediction of the Rotator Cuff Tear and Tear Size. Clin Orthop Surg. 2022;14(4):593–602. doi: 10.4055/cios22073Hsu TH, Lin CL, Wu CW, et al. Accuracy of Critical Shoulder Angle and Acromial Index for Predicting Supraspinatus Tendinopathy. Diagnostics (Basel). 2022;12(2):283. doi: 10.3390/diagnostics12020283Yoo JS, Heo K, Yang JH, Seo JB. Greater tuberosity angle and critical shoulder angle according to the delamination patterns of rotator cuff tear. J Orthop. 2019;16(5):354–358. Erratum in: J Orthop. 2020;24:293. doi: 10.1016/j.jor.2019.03.015Logvinov AN, Il’in DO, Kadantsev PM, et al. Radiographic characteristics of the acromion process as a predictive factor of partial rotator cuff tears. Orthopaedic Genius. 2019;25(1):71–78. doi: 10.18019/1028-4427-2019-25-1-71-78 EDN: VXOZHHLiu CT, Miao JQ, Wang H, et al. The association between acromial anatomy and articular-sided partial thickness of rotator cuff tears. BMC Musculoskelet Disord. 2021;22(1):760. doi: 10.1186/s12891-021-04639-1Borbas P, Hartmann R, Ehrmann C, et al. Acromial Morphology and Its Relation to the Glenoid Is Associated with Different Partial Rotator Cuff Tear Patterns. J Clin Med. 2022;12(1):233. doi: 10.3390/jcm12010233Paim AE. In situ repair of partial articular surface lesions of the supraspinatus tendon. Rev Bras Ortop. 2017;52(3):303–308. doi: 10.1016/j.rboe.2017.04.004Franceschetti E, Giovannetti de Sanctis E, Palumbo A, et al. Lateral Acromioplasty has a Positive Impact on Rotator Cuff Repair in Patients with a Critical Shoulder Angle Greater than 35 Degrees. J Clin Med. 2020;9(12):3950. doi: 10.3390/jcm9123950Björnsson Hallgren HC, Adolfsson L. Neither critical shoulder angle nor acromion index were related with specific pathology 20 years later! Knee Surg Sports Traumatol Arthrosc. 2021;29(8):2648–2655. doi: 10.1007/s00167-021-06602-yChen JJ, Ye Z, Liang JW, Xu YJ. Arthroscopic repair of partial articular supraspinatus tendon avulsion lesions by conversion to full-thickness tears through a small incision. Chin J Traumatol. 2020;23(6):336–340. doi: 10.1016/j.cjtee.2020.07.002Liu J, Dai S, Deng H, et al. Evaluation of the prognostic value of the anatomical characteristics of the bony structures in the shoulder in bursal-sided partial-thickness rotator cuff tears. Front Public Health. 2023;11:1189003. doi: 10.3389/fpubh.2023.1189003Melean P, Lichtenberg S, Montoya F, et al. The acromial index is not predictive for failed rotator cuff repair. Int Orthop. 2013;37(11):2173–9. doi: 10.1007/s00264-013-1963-9Chalmers PN, Salazar D, Steger-May K, et al. Does the Critical Shoulder Angle Correlate with Rotator Cuff Tear Progression? Clin Orthop Relat Res. 2017;475(6):1608–1617. doi: 10.1007/s11999-017-5249-1Gürpınar T, Polat B, Çarkçı E, et al. The Effect of Critical Shoulder Angle on Clinical Scores and Retear Risk After Rotator Cuff Tendon Repair at Short-term Follow Up. Sci Rep. 2019;9(1):12315. doi: 10.1038/s41598-019-48644-wKanatli U, Ayanoğlu T, Ataoğlu MB, et al. Midterm outcomes after arthroscopic repair of partial rotator cuff tears: A retrospective study of correlation between partial tear types and surgical technique. Acta Orthop Traumatol Turc. 2020;54(2):196–201. doi: 10.5152/j.aott.2020.02.486Kocher MS, Horan MP, Briggs KK, et al. Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. J Bone Joint Surg Am. 2005;87(9):2006–11. doi: 10.2106/JBJS.C.01624Goldhahn J, Angst F, Drerup S, et al. Lessons learned during the cross-cultural adaptation of the American Shoulder and Elbow Surgeons shoulder form into German. J Shoulder Elbow Surg. 2008;17(2):248–54. doi: 10.1016/j.jse.2007.06.027Lohr JF, Uhthoff HK. The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res. 1990;(254):35–8.Sano H, Ishii H, Trudel G, Uhthoff HK. Histologic evidence of degeneration at the insertion of 3 rotator cuff tendons: a comparative study with human cadaveric shoulders. J Shoulder Elbow Surg. 1999;8(6):574–9. doi: 10.1016/s1058-2746(99)90092-7Walch G, Boileau P, Noel E, Donell ST. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: An arthroscopic study. J Shoulder Elbow Surg. 1992;1(5):238–45. doi: 10.1016/S1058-2746(09)80065-7Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder. 1972. J Bone Joint Surg Am. 2005;87(6):1399. doi: 10.2106/JBJS.8706.clMoor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint? A radiological study of the critical shoulder angle. Bone Joint J. 2013;95-B(7):935–41. doi: 10.1302/0301-620X.95B7.31028Kim JH, Gwak HC, Kim CW, et al. Difference of Critical Shoulder Angle (CSA) According to Minimal Rotation: Can Minimal Rotation of the Scapula Be Allowed in the Evaluation of CSA? Clin Orthop Surg. 2019;11(3):309–315. doi: 10.4055/cios.2019.11.3.309Chalmers PN, Beck L, Miller M, et al. Acromial morphology is not associated with rotator cuff tearing or repair healing. J Shoulder Elbow Surg. 2020;29(11):2229–2239. doi: 10.1016/j.jse.2019.12.035Suter T, Gerber Popp A, Zhang Y, et al. The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elbow Surg. 2015;24(6):e149–58. doi: 10.1016/j.jse.2014.10.021Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(4):800–5. doi: 10.2106/JBJS.D.03042Ono Y, Woodmass JM, Bois AJ, et al. Arthroscopic Repair of Articular Surface Partial-Thickness Rotator Cuff Tears: Transtendon Technique versus Repair after Completion of the Tear-A Meta-Analysis. Adv Orthop. 2016;2016:7468054. doi: 10.1155/2016/7468054Jordan RW, Bentick K, Saithna A. Transtendinous repair of partial articular sided supraspinatus tears is associated with higher rates of stiffness and significantly inferior early functional scores than tear completion and repair: A systematic review. Orthop Traumatol Surg Res. 2018;104(6):829–837. doi: 10.1016/j.otsr.2018.06.007Gonzalez-Lomas G, Kippe MA, Brown GD, et al. In situ transtendon repair outperforms tear completion and repair for partial articular-sided supraspinatus tendon tears. J Shoulder Elbow Surg. 2008;17(5):722–8. doi: 10.1016/j.jse.2008.01.148Bollier M, Shea K. Systematic review: what surgical technique provides the best outcome for symptomatic partial articular-sided rotator cuff tears? Iowa Orthop J. 2012;32:164–72.Clavert P, Thomazeau H. Peri-articular suprascapular neuropathy. Orthop Traumatol Surg Res. 2014;100(8 Suppl):S409–11. doi: 10.1016/j.otsr.2014.10.002Moen TC, Babatunde OM, Hsu SH, Ahmad CS, Levine WN. Suprascapular neuropathy: what does the literature show? J Shoulder Elbow Surg. 2012;21(6):835–46. Erratum in: J Shoulder Elbow Surg. 2012;21(10):1442. doi: 10.1016/j.jse.2011.11.033Mononeuropathies. Clinical Guidelines. Available from: https://cr.minzdrav.gov.ru/view-cr/166_2?ysclid=macg8gr51l99917029 (In Russ.).Nolte PC, Woolson TE, Elrick BP, et al. Clinical Outcomes of Arthroscopic Suprascapular Nerve Decompression for Suprascapular Neuropathy. Arthroscopy. 2021;37(2):499–507. doi: 10.1016/j.arthro.2020.10.020Momaya AM, Kwapisz A, Choate WS, et al. Clinical outcomes of suprascapular nerve decompression: a systematic review. J Shoulder Elbow Surg. 2018;27(1):172–180. doi: 10.1016/j.jse.2017.09.025Belyak EA, Pashin DL, Lazko FL, et al. Experience of endoscopic decompression of the suprascapular nerve. Clinical practice. 2022;13(2):51–58. doi: 10.17816/clinpract108285. EDN: UUVDWTCofield RH. Tears of rotator cuff. Instr Course Lect. 1981;30:258–73.Lafosse L, Piper K, Lanz U. Arthroscopic suprascapular nerve release: indications and technique. J Shoulder Elbow Surg. 2011;20(2 Suppl):S9–13. doi: 10.1016/j.jse.2010.12.003Costouros JG, Porramatikul M, Lie DT, Warner JJ. Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears. Arthroscopy. 2007;23(11):1152–61. doi: 10.1016/j.arthro.2007.06.014Kong BY, Kim SH, Kim DH, et al. Suprascapular neuropathy in massive rotator cuff tears with severe fatty degeneration in the infraspinatus muscle. Bone Joint J. 2016;98-B(11):1505–1509. doi: 10.1302/0301-620X.98B11.37928Giniyatov AR, Egiazaryan KA, Tamazyan VO, et al. Release suprascapular nerve during arthroscopic suture of the suprascapular muscle. Department of Traumatology and Orthopedics. 2023;(4):7–15. doi: 10.17238/2226-2016-2023-4-7-15 EDN: JLMSFKYang P, Wang C, Zhang D, et al. Comparison of clinical outcome of decompression of suprascapular nerve at spinoglenoid notch for patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy. BMC Musculoskelet Disord. 2021;22(1):202. doi: 10.1186/s12891-021-04075-1Costouros JG, Porramatikul M, Lie DT, Warner JJ. Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears. Arthroscopy. 2007;23(11):1152–61. doi: 10.1016/j.arthro.2007.06.014Sachinis NP, Papagiannopoulos S, Sarris I, Papadopoulos P. Outcomes of Arthroscopic Nerve Release in Patients Treated for Large or Massive Rotator Cuff Tears and Associated Suprascapular Neuropathy: A Prospective, Randomized, Double-Blinded Clinical Trial. Am J Sports Med. 2021;49(9):2301–2308. doi: 10.1177/03635465211021834