Comparison of articular-sided, bursal-sided, and intratendinous partial rotator cuff tears: outcomes of surgical repair from a multicenter cohort study

Outcomes of surgical treatment of partial-thickness rotator cuff tears (PTRCTs) are underreported. This study investigates (1) arthroscopic repair techniques for partial supraspinatus (SSP) tears and (2) outcomes based on tear location (articular-side vs. bursal-side vs. intratendinous) in a large multicenter cohort. As part of a cohort study across 19 centers (ARCR_Pred study), adult patients with primary arthroscopic repair of a PTRCT involving the SSP tendon were prospectively enrolled over an 18-month period beginning in June 2020, operated, and followed-up for 24 months. Tear location (articular-side, bursal-side, intratendinous) and surgical technique (tear completion, suture configuration) were documented. Functional (pain, strength, Range of Motion [ROM], Constant -Murley Score [CMS]) and patient-reported (Subjective Shoulder Value [SSV], quality of life [Eq. 5D utility]) outcomes were assessed at baseline, 6, 12, and 24 months. Adverse events were recorded through 24 months. Baseline factors affecting repair techniques were explored. Outcomes and adverse events were compared across tear locations. The ARCR_Pred cohort of 973 patients included 147 partial tears (15.7%), with 128 (87%) involving the SSP tendon: 69 (54%) articular-sided, 35 (27%) bursal-sided, and 24 (19%) intratendinous. SSP PTRCTs were repaired in 121 patients using single-row (45%) or double-row (55%) techniques. Completion of partial tears was performed in 46% of articular-sided and 35% of bursal-sided tears, and was positively associated with tendon thickness (p = 0.001). Completed tears were 1.4 times more likely to be repaired using double-row sutures (p = 0.037). ROM for flexion was greater in articular-sided tears (p = 0.010) compared to bursal-sided tears. Other outcome parameters showed overall no significant differences between groups (p ≥ 0.141) with a tendency for faster recovery in the bursal-sided tears. Adverse events were mostly mild, with pain (15.7%) and stiffness (13.2%) being common. Severe adverse events (Grade III) were rare, occurring in 3% (4/121) of cases. Arthroscopic rotator cuff repair is safe and effective for PTRCTs showing postoperative improvement in shoulder function and patient quality of life. Flexion ROM recovered better in articular-sided tears than bursal-sided tears. Surgical techniques varied, influenced by tendon thickness and tear completion. ClinicalTrial.gov registration number NCT04321005. Questions (1) What are the profiles of partial-thickness rotator cuff tear and arthroscopic surgical repair techniques used in Switzerland? (2) Do outcomes of different partial-thickness tears vary based on the tear location? Findings The majority of PTRCTs involved the supraspinatus (SSP) tendon, with 54% articular-sided, 27% bursal-sided, and 19% intratendinous tears. Various surgical techniques were used, including single-row and double-row repairs, the latter being 1.4 times more likely in case of tear completion. All tear types showed significant postoperative improvements in functional and quality of life outcomes. However, range of motion (ROM) for flexion and abduction recovered significantly better in articular-sided tears compared to bursal-sided. The risk of severe adverse events (Grade III or higher) was low across all tear types. Meaning Arthroscopic rotator cuff repair is a safe and effective treatment for all PTRCTs, leading to significant improvements objective and subjective outcomes. While articular-sided tears show superior flexion recovery at 12 months, overall outcomes are comparable across tear types. The procedure carries a low risk of severe complications, though minor complications such as stiffness or pain may be underreported.