Intratendinous rotator cuff tears: prevalence and clinical and radiological outcomes of arthroscopically confirmed intratendinous tears at midterm follow-up.
BACKGROUND
Intratendinous tears of the rotator cuff are rare, and little has been written about them.


OBJECTIVE
To investigate the prevalence and clinical and radiological outcomes of arthroscopically confirmed intratendinous tears treated with transtendon suture bridge repair.


METHODS
Case series; Level of evidence, 4.


METHODS
Included in the study were 33 patients (16 male, 17 female; mean age, 53.4 years) with arthroscopically confirmed intratendinous tears treated with transtendon suture bridge repair from March 2006 to July 2012. A history of trauma was found in 10 cases (30.3%). The dominant arm was involved in 26 cases (78.8%). The mean follow-up duration was 56 months. Preoperatively, a thorough physical examination was performed; at final follow-up, shoulder range of motion (ROM) in forward flexion, abduction, external rotation (ER) at the side, and internal rotation (IR) at the back was noted, and clinical outcomes (American Shoulder and Elbow Surgeons [ASES] score; University of California, Los Angeles [UCLA] score; visual analog scale [VAS] for pain; and Simple Shoulder Test [SST]) were recorded and compared with the preoperative data. Postoperative magnetic resonance imaging (MRI) was performed at 6 months to investigate rotator cuff healing status and repair integrity.


RESULTS
The prevalence of arthroscopically confirmed intratendinous tears was 4.7% among all arthroscopically treated partial-thickness rotator cuff tears. Impingement signs were positive in most of the patients (positive Hawkins-Kennedy test result in 78.8%, positive Neer sign in 66.7%, and either positive Hawkins-Kennedy test result or Neer sign in 84.8%). At final follow-up, mean ASES, UCLA, VAS, and SST scores improved significantly from a preoperative mean of 51.4, 18.9, 6.0, and 5.4, respectively, to a postoperative mean of 90.6, 32.9, 1.4, and 10.8, respectively (P < .001). According to the UCLA rating scale, outcomes were excellent in 17, good in 13, and fair in 3 cases. Shoulder ROM in forward flexion, abduction, ER at the side, and IR at the back improved from a preoperative mean of 135°, 129°, 25°, and L2, respectively, to a postoperative mean of 161°, 160°, 29°, and T10, respectively (P < .001 for all except ER). As per the Sugaya classification, on postoperative MRI, type I healing status was found in 10 (30.3%), type II in 18 (54.5%), and type III in 2 (6.1%) cases. None of the patients showed any evidence of retears.


CONCLUSIONS
Transtendon suture bridge repair yielded satisfactory clinical and radiological outcomes in patients with intratendinous rotator cuff tears.
Department of Orthopedic Surgery, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
Sang-Eun
SE
Park
Department of Orthopedic Surgery, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
Karnav
K
Panchal
Department of Orthopedic Surgery, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
Jae-Jung
JJ
Jeong
Department of Orthopedic Surgery, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
Young-Yul
YY
Kim
Department of Orthopedic Surgery, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
Jong-Ho
JH
Kim
Department of Orthopedic Surgery, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
Ju-Yeob
JY
Lee
Department of Orthopedic Surgery, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea jijh87@gmail.com.
Jong-Hun
JH
Ji
D000328:Adult; D000368:Aged; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D022125:Lacerations / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D015995:Prevalence; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000503:physiopathology* / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing
arthroscopic surgery; intratendinous tears; prevalence; transtendon suture bridge repair