Partial Thickness Tears



Pain & Stiffness

- often more pain than FT tears


Bursal side tears more painful than articular


Articular side more common


May see in young patient overhead throwing




Painful arc


Impingement signs


No weakness

- function good

- cable system intact




Articular sided more common than bursal



- A (articular)

- B (Bursal)


Grade 1    <  3mm

Grade 2    <  3-6 mm

Grade 3    <  6 mm footprint exposed




Sher et al JBJS Am 1995

- 19 - 39 years - 4% PT , no FT

- > 60 years - 26% PT, 28% FT




Yamanaka et al Clin Orthop 1994

- 40 patients with articular sided PT

- a few heal 10%

- a few don't progress 10%

- 50% enlarge

- 30% become FT




Articular Sided


Shoulder MRI Footprint Exposure Supraspinatous Articular TearShoulder MRI Articular Supraspinatous Tear


Bursal Sided




Articular side




Rotator Cuff Small Partial Articular TearPartial Articular Supraspinatous Tear



- see uncovering of footprint

- SS inserts laterally

- bare area lateral to cartilage


PASAT Arthroscopy 1PASTA Arthroscopy 2


Bursal Sided


Shoulder Scope Bursal Supraspinatous TearSupraspinatous Bursal Sided Tear




Non Operative


Physio / HCLA






1.  Failure of non operative treatment (6-12 months)

2.  Symptomatic pain or weakness

3.  Repair if > 50% depth




1.  Acromioplasty and debridement

2.  Conversion to FT and repair

3.  Repair without conversion to FT


1.  Acromioplasty + debridement



- < 50% tears


Shoulder Scope PASTA Debridement




Park et al Orthopaedics 2003

- 37 patients PT < 50%

- 87% good results at 2 years


Weber Arthroscopy 1999

- 63 patients with grade 3A / 3B

- mini open repair v acromioplasty / debridement

- significantly improved results with repair


Cordasco et al Am J Sports Med 2002

- SAD and debridement

- 2A 5% failure rate

- 2B 38% failure rate

- recommend repair 2B PT



- bursal sided tears tend to do more poorly than articular sided

- repair > 50% especially in young patients


2.  Acromioplasty and repair


May be done open / arthroscopically / arthroscopically + mini open



A. Convert to FT and repair

- arthroscopic or open

B. Transtendinous articular repair

- must be done arthroscopically

C.  Bursal repair

- can be done arthroscopically or open


A.  Convert to FT and repair


Kamath et al JBJS Am 2009

- 42 > 50% PT converted to FT arthroscopically

- 88% cuff intact on US

- 93% patient satisfaction


B.  Articular sided / transtendinous PASTA repair


Gonzalez J Shoulder Elbow Surg 2008

- biomechanical study of PT articular

- coversion to FT and double row repair v

- transtendinous repair of PT

- transtendinous repair higher ultimate strength and

- decreased gap formation


Ide et al Am J Sports Med 2005

- all arthroscopic transtendinous repair 3A PT

- 14 / 17 excellent, 2 good, 1 fair


C.  Bursal sided

- can repair top layer of tear only


Technique Transtendinous Arthroscopic PASTA Repair 



- repair medial footprint

- don't injure intact tendon

- can range immediately

- in fact need to do so to avoid stiffness




Camera in glenohumeral joint

- anterior glenohumeral cannula for suture management

- 5mm anchor passed through SS transtendinous into footprint

- retrieve sutures through anterior GH portal


Shoulder Partial Articular Supraspinatous Tear PASTA


Must pass sutures from anchor through torn cuff

- aim to reapproximate to footprint


A.  Pass bird beak suture passers through cuff to retrieve sutures


B.  Pass 20G spinal needle and pass down 0 nylon, retrieve via anterior portal

- tie to thread, and pass suture back through tendon

- do so each time for each thread in horizontal mattress pattern


Shoulder PASTA Repair Needle Suture ShuttleShoulder PASTA Repair Sutures Shuttled


Camera into subacromial space

- lateral portal

- retrieve sutures and tie

- check repair again via GHJ


Shoulder PASTA Repair Sutures in Subacromial SpaceShoulder PASTA Repair Knots Tied Subacromial Space


Post op

- can range aggressively

- the repair is protected by the intact portion of the tendon

- prevents stiffness


Technique Open Articular PT Tears



- put spinal needle through torn portion

- pass suture through to mark tendon


Open approach over needle entry

- identify tear by suture

- convert to FT and repair


Technique Arthroscopic Bursal Sided Tear


Identify tear

- see partial uncovering footprint

- camera in subacromial space

- debride tear edges

- prepare footprint insertion


Insert anchor

- pass sutures through top layer of torn tendon

- tie down


Bursal Sided Supraspinatous TearBursal Sided Supraspinatous Tear Repair