Excellent Outcomes and High Rates of Return to Duty but a 10% Chance of Tear Progression Are Seen Following Arthroscopic Debridement Alongside Adjunctive Procedures for Articular‐Sided, Partial‐Thickness Supraspinatus Tears (Ellman Grade I) in Active‐Duty Service Members Younger Than 50 Years

Purpose To evaluate clinical outcomes and return‐to‐duty rates in active‐duty service members younger than 50 years after arthroscopic debridement of Ellman grade I, articular‐sided partial‐thickness rotator cuff tears (PT‐RCTs) of the supraspinatus. Methods A retrospective review of active‐duty service members under 50 who underwent arthroscopic debridement of Ellman grade I PT‐RCTs without associated cartilage lesions, labral repair, or rotator cuff repair between January 2014 and June 2022 with ≥24 months of follow‐up was conducted. Outcomes included pain Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), and American Shoulder and Elbow Surgeons (ASES) scores; achievement of minimal clinically important difference (MCID) (½ standard deviation method); and range of motion (ROM), return to activity, adverse events, and tear progression. Results In total, 67 patients met inclusion criteria (mean age 39.6 ± 7.1 years, 59.7% male, 5.6 ± 2.4 years of follow‐up). All patients underwent adjunctive subacromial decompression, 56.7% biceps tenotomy/tenodesis, 37.3% acromioclavicular joint resection, and 17.9% rotator interval release. Significant improvements in pain and functional outcomes were observed postoperatively (VAS: 8.1 ± 1.4 to 1.7± 2.5, P < .0001; SANE: 49.0 ± 19.2 to 84.7 ± 16.5, P < .001; ASES: 47.6 ± 10.23 to 87.8 ± 14.6, P < .001), and the MCID was achieved in most patients (VAS: 92.5%, SANE 82.1%, ASES: 89.6%). ROM did not change significantly. Return to unrestricted active duty was achieved by 88% of patients (n = 59) and preinjury level of sport by 85.1% (n = 57). S patients (10.5%) progressed to symptomatic full‐thickness rotator cuff tears that warranted rotator cuff repair. Conclusions Arthroscopic debridement of Ellman grade I, articular‐sided supraspinatus PT‐RCT with adjunctive procedures in active‐duty service members younger than 50 years shows substantial pain relief, functional recovery, and return to military service and sport. Despite improvements in pain relief and functional outcomes, approximately 1 in 10 patients experienced atraumatic tear progression to a symptomatic full‐thickness rotator cuff tear and ultimately underwent rotator cuff repair. Level of Evidence Level IV, retrospective therapeutic case series.