Bursal sided cuff tears, should they be repaired?

 A comparative study of arthroscopic debridement versus repair for Ellman grade II bursal-side partial-thickness rotator cuff tears

These authors compared clinical outcomes of arthroscopic debridement vs. repair for Ellman grade II bursal-side partialthickness rotator cuff tears (i.e. those 3-6 mm deep and not exceeding one half of the tendon thickness). 

On the basis of preoperative findings and patient preference, 20 patients underwent debridement whereas 26 underwent arthroscopic repair. 

The rehabilitation program was over twice as long for the patients having repair in contrast to those having debridement:

In patients who underwent arthroscopic debridement, the affected arm was kept in a sling at 15 of abduction and a neutral-rotation brace for 3 weeks. Pendulum and passive ROM exercises were initiated on postoperative day 1. After 3 weeks, patients were encouraged to start self-assisted passive and active ROM exercises. Active strengthening exercises using an elastic band were started at 4-10 weeks postoperatively. Nearly full active ROM was allowed starting at 2.5 months postoperatively.

In patients who underwent RCT repair, the affected arm was kept in an abduction brace for 6 weeks. Pendulum and passive ROM exercises were initiated on postoperative day 1. Self-assisted passive exercises were started at 6-12 weeks postoperatively, and active ROM exercises were conducted starting at 12 weeks postoperatively. Active strengthening exercises using an elastic band were started at 3-6 months postoperatively. Nearly full active ROM was allowed starting at 6 months postoperatively.

All patient-reported outcomes improved in both groups. Outcome scores were better for the debridement group at 6 months postoperatively. 

The authors concluded that arthroscopic debridement and repair of Ellman grade II bursal-side partial-thickness rotator cuff tears achieved comparable clinical scores and low retear rates during 2 years of follow-up. Debridement achieved better results, especially within 6 months postoperatively, and achieved a favorable prognosis up to 2 years postoperatively.

Comment: This study demonstrates the value of simple debridement in the management of burial sided cuff tears: (1) the outcomes are reported to be better at 6 months,  (2) the cost of suture anchors and increased surgical time is avoided, and (3) the protracted rehabilitation program associated with a cuff repair is avoided.

The technique and value of debridement in the management of cuff tears, including those that are irreparable is shown in this link on the smooth and move procedure.

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Shoulder arthritis, why not just clean it up with an arthroscope?

Arthroscopic Debridement and Capsular Release for the Treatment of Shoulder Osteoarthritis

These authors performed a retrospective review of 33 patients having arthroscopic debridement and capsular release for shoulder osteoarthritis.

Their technique included debridement of loose cartilage, frayed labrum, and other degenerative tissues as well as complete release of the rotator interval, middle, and inferior glenohumeral ligaments.

A patient-directed home exercise program was initiated immediately for stretching and range of motion therapy.

While there appeared to be an initial improvement in range of motion and pain scores, patients returned to preoperative status 4 months after debridement and capsular release. Twenty patients (61%) reported dissatisfaction with the outcome of the procedure. Over 40% of the shoulders had total shoulders at an average of 9 months.

Comment: This information is useful. We often find patient's asking, 'can't you just clean up my shoulder arthritis without a joint replacement?' It is a good question and comes to the complexity of glenohumeral degenerative joint disease, which, as the picture below suggests, may include loss of cartilage, loss of the roundness of the joint surfaces, bone spurs (osteophytes), instability, capsular tightness, and muscle imbalance - features that are difficult to manage without arthroplasty.

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