Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes

The effect of age on the outcomes of arthroscopic repair of type II superior labral anterior and posterior lesions

BACKGROUND

The majority of clinical outcome studies of type II superior labral anterior and posterior (SLAP) repair assess patients younger than age 40. Biceps tenotomy or tenodesis is often recommended for patients older than age 40 with superior labrum-biceps complex injury.

HYPOTHESIS

There is no difference in patient clinical outcomes comparing arthroscopic type II SLAP repair in patients younger or older than age 40.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Fifty-two patients stratified to groups younger than age 40 (21 patients; average age, 32.9 years) and older than age 40 (31 patients; average age, 55.1 years) were identified at a minimum 2-year follow-up (average, 28 months) after type II SLAP repair by a single surgeon using suture anchors. Outcome scores included American Shoulder and Elbow Society scores (ASES), Short Form-12 scores, Simple Shoulder Test scores, and visual analog pain scale.

RESULTS

At follow-up, there was no statistical difference in visual analog pain scale (P = .16), ASES scores (P = .07), Simple Shoulder Test scores (P =.41), Short Form-12 testing, or range of motion testing. Patients older than age 40 noted their shoulder to be 87% of normal; 26 of 31 (84%) were satisfied to completely satisfied, and 28 of 31 (90%) would have the surgery again. Patients younger than 40 noted their shoulder to be approximately 89% of normal; 20 of 21 (95%) were satisfied to completely satisfied, and 18 of 21 (86%) would have the same procedure performed again.

CONCLUSION

Our findings support that arthroscopic treatment of isolated type II SLAP repair using suture anchors can yield good to excellent results in patients older and younger than age 40. We found no statistically significant difference in patient outcome scores, satisfaction levels, or willingness to have the same procedure again when comparing arthroscopic SLAP repair in patients younger or older than age 40.

Management of the throwing shoulder: cuff, labrum and internal impingement

Repetitive throwing or other overhead activity places great stress on the shoulder. As a result, the shoulder is a common site of injury in athletes. Addressing throwing-related injuries requires an understanding of throwing biomechanics and pathology. Nonoperative treatment is directed at restoring strength, flexibility, and neuromuscular control to the entire kinetic chain. Surgery is indicated when nonoperative treatment fails, and is directed at correcting labral, capsular, and rotator cuff pathology.

The outcome of type II SLAP repair: a systematic review

PURPOSE

The purpose of this study was to systematically review the literature regarding the outcome of arthroscopic repair of type II SLAP lesions in order to assess the effectiveness of current methods of treatment.

METHODS

We performed a systematic review of the results of repair of type II SLAP lesions. Inclusion criteria included outcome studies of repair of type II SLAP lesions with minimum 2-year follow-up and Level IV evidence or higher published in the English language in peer-reviewed journals.

RESULTS

There is no Level I or II evidence for SLAP repair outcome. Regarding the general outcome after type II SLAP repair, the percentage of good and excellent results ranged from 40% to 94%. Return to previous level of play ranged from 20% to 94%. Overhead athletes are the most challenging to return to the previous level of performance for this diagnosis, and their return rate reflects this. Five studies reported these results, and the rate of return ranged from 22% to 64% for baseball players.

CONCLUSIONS

Arthroscopic repair of type II SLAP tears results in overall excellent results for individuals not involved in throwing or overhead sports. The results of type II SLAP repair in throwing or overhead athletes are much less predictable. Future studies should be prospective in nature and at least use a longitudinal prospective cohort design to determine predictors of outcome.

LEVEL OF EVIDENCE

Level IV, systematic review of Level III and IV studies.

Does a SLAP lesion affect shoulder muscle recruitment as measured by EMG activity during a rugby tackle?

BACKGROUND

The study objective was to assess the influence of a SLAP lesion on onset of EMG activity in shoulder muscles during a front on rugby football tackle within professional rugby players.

METHODS

Mixed cross-sectional study evaluating between and within group differences in EMG onset times. Testing was carried out within the physiotherapy department of a university sports medicine clinic. The test group consisted of 7 players with clinically diagnosed SLAP lesions, later verified on arthroscopy. The reference group consisted of 15 uninjured and full time professional rugby players from within the same playing squad. Controlled tackles were performed against a tackle dummy. Onset of EMG activity was assessed from surface EMG of Pectorialis Major, Biceps Brachii, Latissimus Dorsi, Serratus Anterior and Infraspinatus muscles relative to time of impact. Analysis of differences in activation timing between muscles and limbs (injured versus non-injured side and non injured side versus matched reference group).

RESULTS

Serratus Anterior was activated prior to all other muscles in all (P = 0.001-0.03) subjects. In the SLAP injured shoulder Biceps was activated later than in the non-injured side. Onset times of all muscles of the non-injured shoulder in the injured player were consistently earlier compared with the reference group. Whereas, within the injured shoulder, all muscle activation timings were later than in the reference group.

CONCLUSIONS

This study shows that in shoulders with a SLAP lesion there is a trend towards delay in activation time of Biceps and other muscles with the exception of an associated earlier onset of activation of Serratus anterior, possibly due to a coping strategy to protect glenohumeral stability and thoraco-scapular stability. This trend was not statistically significant in all cases.

Superior labral tears of the shoulder: pathogenesis, evaluation, and treatment

Lesions of the superior glenoid labrum and biceps anchor are a well-recognized cause of shoulder pain. Advances in shoulder arthroscopy have led to improvements in recognizing and managing superior labral anterior-posterior (SLAP) tears. Recent biomechanical studies have postulated several theories for the pathogenesis of SLAP tears in throwing athletes and the effect of these injuries on normal shoulder kinematics. Advances in soft-tissue imaging techniques have resulted in improved accuracy in diagnosing SLAP tears. However, the diagnosis of clinically relevant SLAP tears remains challenging because of the lack of specific examination findings and the frequency of concomitant shoulder injuries. Definitive diagnosis of suspected SLAP tears is confirmed on arthroscopic examination. Advances in surgical techniques have made it possible to achieve secure repair in selected patterns of injury. Recent outcomes studies have shown predictably good functional results and an acceptable rate of return to sport and/or work with arthroscopic treatment of SLAP tears.

[Multidirectional shoulder instability. Nonoperative and operative treatment strategies]

Multidirectional shoulder instability (MDI) is characterized by symptomatic instability in at least two directions, often with a global hyperlaxity. The etiology is mostly atraumatic, with an acquired or congenital enlarged capsular volume or redundancy. Muscular imbalances and pathologic patterns of muscle recruitment and motion are also common findings. Traumatic onset of MDI is rare, although capsulolabral lesions can be found during surgery. Therapy aims at a normalization of muscle balance/weakness and motion patterns. If conservative treatment fails, arthroscopic capsular plication techniques, in combination with repair of labral and interval lesions, can accomplish results similar to those of classic open techniques but with reduced morbidity and invasiveness.

Outcomes after arthroscopic repair of type-II SLAP lesions

BACKGROUND

To our knowledge, there has been no prospective study on the results of arthroscopic repair of superior labrum-biceps anchor complex (SLAP) tears with use of modern techniques. The purpose of the present study was to prospectively evaluate the minimum two-year results for patients with type-II SLAP tears that were treated with arthroscopic suture anchor fixation.

METHODS

Forty-seven patients with symptomatic type-II SLAP tears were evaluated preoperatively and at least two years postoperatively with use of the American Shoulder and Elbow Surgeons (ASES) and L'Insalata outcomes instruments and physical examination. The study group included thirty-nine male and eight female patients with a mean age of thirty-six years; thirty-four of the forty-seven patients were athletes. Patients with rotator cuff tears requiring repair or concomitant shoulder instability were excluded.

RESULTS

At an average of 2.7 years, the median ASES and L'Insalata scores were 97 and 93, respectively, compared with baseline scores of 62 and 65 (p < 0.05). The median patient-reported satisfaction rating was 9 (of 10); forty-one patients (87%) rated the outcome as good or excellent. The median patient-reported satisfaction rating was significantly higher for patients with a discrete traumatic etiology than for those with an atraumatic etiology (9 compared with 7); however, there was no significant difference between these groups in terms of the ASES or L'Insalata outcome scores. Overall, twenty-five (74%) of the thirty-four athletes were able to return to their preinjury level of competition, whereas eleven (92%) of the twelve athletes who reported a discrete traumatic event were able to return to their previous level of competition. There were five complications, including four cases of refractory postoperative stiffness.

CONCLUSIONS

Our findings indicate that favorable outcomes can be anticipated in the majority of patients after arthroscopic SLAP lesion repair. While only three of four patients overall may be capable of returning fully to their previous level of competition, patients with a distinct traumatic etiology have a greater likelihood of a successful return to sports.

Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion

BACKGROUND

Overhead athletes report an inconsistent return to their previous level of sport and satisfaction after arthroscopic SLAP lesion repair.

HYPOTHESIS

Arthroscopic biceps tenodesis offers a viable alternative to the repair of an isolated type II SLAP lesion.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Twenty-five consecutive patients operated for an isolated type II SLAP lesion between 2000 and 2004 were evaluated at a mean of 35 months postoperatively (range, 24-69). Patients with associated instability, rotator cuff rupture, posterosuperior impingement, or previous shoulder surgery were excluded. Ten patients (10 men) with an average age of 37 years (range, 19-57) had a SLAP repair performed with suture anchors. Fifteen patients (9 men and 6 women) with an average age of 52 years (range, 28-64) underwent arthroscopic biceps tenodesis performed with an absorbable interference screw. Arthroscopic diagnosis and treatment were performed by a single experienced shoulder surgeon, and all patients were reviewed by an independent examiner.

RESULTS

In the repair group, the Constant score improved from 65 to 83 points; however, 60% (6 of 10) of the patients were disappointed because of persistent pain or inability to return to their previous level of sports participation. In the tenodesis group, the Constant score improved from 59 to 89 points, and 93% (14/15) were satisfied or very satisfied. Thirteen patients (87%) were able to return to their previous level of sports participation following biceps tenodesis, compared with only 20% (2 of 10) after SLAP repair (P = .01). Four patients with failed SLAP repairs underwent subsequent biceps tenodesis, resulting in a successful outcome and a full return to their previous level of sports activity.

CONCLUSION

Arthroscopic biceps tenodesis can be considered an effective alternative to the repair of a type II SLAP lesion, allowing patients to return to a presurgical level of activity and sports participation. The results of biceps reinsertion are disappointing compared with biceps tenodesis. Furthermore, biceps tenodesis may provide a viable alternative for the salvage of a failed SLAP repair. As the age of the 2 treatment groups differed, these findings should be confirmed by future studies.

Superior labral lesions anterior to posterior-evaluation and arthroscopic management

Lesions of the superior labrum are complex and difficult to both diagnose and treat effectively. The clinical diagnosis is challenging due to the nonspecific history and physical examination. MRI has substantially improved our ability to detect SLAP tears, although experience is necessary to distinguish pathologic findings from normal anatomic variants. Treatment is determined by patient age, functional demands, and the type of lesion identified.

SLAP lesions: an update on recognition and treatment

Superior labral tears (SLAP lesions) can pose a significant challenge to orthopaedic surgeons and rehabilitation specialists alike. Although advancement in arthroscopic techniques has enhanced arthroscopic repair of SLAP lesions, the clinical diagnosis of SLAP lesions can still be difficult. There is a variety of etiologic factors associated with SLAP lesions and a thorough clinical evaluation is crucial to make the diagnosis. Concomitant injury to the capsular-labral complex or rotator cuff is not uncommon and can further confuse the clinical presentation. The purpose of this paper is to review the pathomechanics, diagnosis, and treatment of SLAP lesions. We will specifically review some of the physical examination tests that are used to diagnose SLAP lesions and report on our technique of arthroscopic repair. Additionally, we will discuss the operative management of associated intra-articular pathology and, finally, we will briefly discuss our postoperative rehabilitation guidelines.

LEVEL OF EVIDENCE

Level 5.

Correlation of the SLAP lesion with lesions of the medial sheath of the biceps tendon and intra-articular subscapularis tendon

BACKGROUND

Superior labral anterior to posterior (SLAP) lesions have been well described in the literature and are thought to be secondary to traction injuries to the biceps anchor and/or falls on the outstretched arm. The pulley has recently been described as a structure that aids in the prevention of biceps instability. The intra-articular subscapularis insertion (IASS) has been noted to contribute to the robust nature of the medial sheath. The purpose of the study was to determine a potential correlation of SLAP lesions and pulley lesions with/without IASS lesions, (hereafter referred to as medial sheath) as forces that can disrupt the biceps anchor and may also disrupt structures of the medial sheath or vice-versa.

MATERIALS AND METHODS

Three hundred and sixteen consecutive shoulder arthroscopies performed by one surgeon were reviewed retrospectively. Operative reports and arthroscopic pictures were carefully reviewed with particular attention paid to the labral and pulley pathology. Selection bias was noted as the author had never operated primarily for a Type 1 SLAP lesion. Following, however, and as such, the exclusion criteria, was a Type 1 SLAP.

RESULTS

There were a total of 30 SLAP lesions and a total of 126 medial sheath lesions. There were 13 patients who had both SLAP and medial sheath lesions. There were 17 patients who had a SLAP lesion without a medial sheath lesion. There were 96 medial sheath lesions without a SLAP. A comparison of rates between patients who had a medial sheath lesion with a SLAP and those who had a medial sheath lesion without a SLAP, for the 316 patients, and when tested with a Fisher exact test revealed that there was no statistical significance, P = 0.673. The prevalence of SLAP lesions in this population of 316 patients was 9.4%, Buford 1%, medial sheath lesions 39%, and SLAP and medial sheath lesions 4%. Interestingly, there were three Buford complexes, all associated with a SLAP and one Buford complex was associated with both a SLAP and a pulley. When looking at the rate for medial sheath lesions when restricted to patients with SLAP lesions, the medial sheath lesion rate was 43.3% (13/30; 95% confidence interval 19.6-66.9%). The medial sheath lesion rate for patients with SLAP lesions differs from a rate of zero and is statistically significant, with a P value <0.05. In other words, when a SLAP lesion is present there is a statistically significant rate of medial sheath lesions, a previously unpublished association.

CONCLUSIONS

With a 43% association of the medial sheath lesion with SLAP lesions, the author postulates that forces that affect the biceps anchor may also damage the pulley system of the bicipital sheath and, as such, this anatomic structure should be evaluated, especially when SLAP lesions are present.

Trans-rotator cuff portal is safe for arthroscopic superior labral anterior and posterior lesion repair: clinical and radiological analysis of 58 SLAP lesions

BACKGROUND

There are numerous accessory portals for the arthroscopic repair of superior labral anterior and posterior lesions. Many surgeons are reluctant to make a portal through the cuff because of concern about iatrogenic injury to the cuff.

HYPOTHESIS

An arthroscopic superior labral anterior and posterior lesion repair procedure using the trans-rotator cuff portal may yield favorable clinical and radiological outcomes, and cuffs may heal properly.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Fifty-eight consecutive patients undergoing superior labral anterior and posterior lesion repair using the trans-rotator cuff portal, who had available both functional and radiological outcomes after 1 year of the operation, were enrolled. We evaluated the structural outcomes for the labrum and cuff using computed tomographic arthrography and measured various clinical outcomes (the supraspinatus power, visual analog scale for pain and satisfaction, American Shoulder and Elbow Surgeons shoulder evaluation form, University of California-Los Angeles shoulder score, Constant score, and Simple Shoulder Test) at the final visit.

RESULTS

All functional outcomes were improved significantly (P < .001). On computed tomographic arthrography, labral healing to the bony glenoid was achieved in all patients. Subacromial leakage of contrast media was observed in 3 patients (5.2%) through the muscular portion without any retraction or gap of the tendon. Two of 3 had preoperative cuff pathologic changes, and they were older than 45 years of age. Partial articular cuff tears were observed in 6 patients (10.3%), and 4 had the lesion preoperatively. There were no statistical differences in functional scores according to the presence of preoperative lesion, postoperative leakage, or partial cuff tear.

CONCLUSION

The data demonstrate favorable outcomes for arthroscopic superior labral anterior and posterior lesion repair using the trans-rotator cuff portal. We suggest that the trans-rotator cuff portal is an efficient and safe portal for superior labral anterior and posterior lesion repair, although there are some valid concerns of damaging the cuff in patients with a superior labral anterior and posterior lesion with concurrent cuff disorders, as well as in older patients.

Posterosuperior suture granuloma impingement after arthroscopic SLAP repair using suture anchors: a case report

Arthroscopic refixation of the glenoid labrum has become a standard treatment of type II SLAP lesions although postoperative results are not uniformly good due to factors which are yet unclear. We present the case of an active overhead athlete with an intraarticular posterosuperior impingement syndrome arising from a suture granuloma formation complicating the postoperative course after arthroscopic SLAP repair. The symptoms resolved completely following revision arthroscopy during which the granuloma and the permanent sutures were removed. Implant related complications should be considered when patients present with recurrent pain after arthroscopic SLAP repair using suture anchors, in particular during overhead activity.

Outcomes of isolated glenoid labral injuries in professional baseball pitchers

BACKGROUND

Major League Baseball (MLB) pitchers who return to competition after labral surgery show a decline in their pitching performance.

DESIGN

Retrospective cohort.

SETTING

Tertiary institution.

PATIENTS

MLB starting or relief pitchers with isolated glenoid labral injuries.

INTERVENTIONS

Open or arthroscopic surgical repair of isolated glenoid labral injuries.

MAIN OUTCOME MEASUREMENTS

Individual statistics were reviewed for 42 MLB pitchers who underwent surgical repair of isolated glenoid labral injuries of their throwing shoulder between 1998 and 2003. Pertinent statistical data, including earned run average (ERA), innings pitched (IP), and walks plus hits per inning pitched (WHIP), were obtained for all players and compared before and after surgery. These statistics were evaluated for an association with demographic factors, pitching role, and rehabilitation time.

RESULTS

A total of 42 MLB pitchers (26 starters, 16 relievers) were included in the study with an average age of 27.5 years for starters and 29.9 years for relievers at injury time. There were 30 right-handed pitchers and 12 left-handed pitchers. In all, 69% of pitchers returned postoperatively to MLB for at least one season; 29% pitched for three seasons or more. For both relievers and starters, there was no statistically significant postoperative change in ERA or WHIP at 1 and 3 years. Starters had significantly decreased IP at 1 year, but not at 3 years. Relievers had no significant change in IP at 1 year postoperatively, but IP were significantly decreased at 3 years. Relievers missed less time after surgery than did starters (11.4 vs. 18.4 months).

CONCLUSIONS

Most pitchers who were able to return to competition after surgery showed insignificant changes in ERA and WHIP and significant decreases in IP. Age, MLB experience, and pitching role as a reliever were the most significant factors related to a successful return after surgery.

Long-term outcome of a transglenoid suture technique for anterior shoulder instability in young adults

We reviewed the outcome of arthroscopic stabilisation of anterior glenohumeral instability in young adults using the transglenoid suture technique. A questionnaire was sent to 455 consecutive patients who had undergone this procedure between 1992 and 2000. Of these, 312 patients (68.5%) with 313 affected shoulders and a mean age of 20 years (18 to 28) responded.

Outcome was determined by the number of re-dislocations or, in patients who had not re-dislocated, by the disease-specific quality of life as measured by the Western Ontario Shoulder Instability index. During a mean follow-up of 6.4 years (1 to 14), 177 patients (56%) sustained a re-dislocation, including 70 who required a further operation. In 136 patients (44%) who reported neither re-dislocation nor re-operation, the index scores were good (median 90.4%; 28.9% to 100%). No significant peri- or pre-operative predictors of re-dislocation or re-operation were found.

We found a high rate of re-dislocation after transglenoid suture repair in young, physically active patients.

Isolated and combined Type II SLAP repairs in a military population

The study compares the clinical results of isolated arthroscopic repair of Type II SLAP tears with those of combined treatment for Type II SLAP and other associated shoulder conditions. The population was composed of 36 aged-matched active duty males with a mean age of 31.6 years (range 22-41 years); mean follow-up was 29.1 months (range 24-42 months). Eighteen subjects in Group I had isolated Type II SLAP tears. Eighteen subjects in Group II had Type II SLAP tear and concomitant ipsilateral shoulder conditions, including subacromial impingement in six patients, acromioclavicular arthrosis in three patients, subacromial impingement and acromioclavicular arthrosis in four patients, spinoglenoid cyst in four patients, and intra-articular loose bodies in one patient. Arthroscopic SLAP repair was performed with biodegradable suture anchors. Subacromial decompression and spinoglenoid cyst decompression were performed arthroscopically. Distal claviculectomy was performed in open fashion. Loose bodies were removed arthroscopically. At minimum 2-year follow-up, the mean UCLA score for Group I (30.2 +/- 3.0 points) was not significantly different from Group II (30.8 +/- 2.0 points) (P = 0.48). The mean post-operative ASES score for Group I (84.1 +/- 13.4 points) was significantly lower than for Group II (91.8 +/- 5.4 points) (P < 0.04). The mean VAS pain score for Group I (1.6 +/- 1.3 points) was significantly higher than for Group II (0.7 +/- 0.7 points) (P < 0.02). Seventeen of 18 patients (94%) in each group returned to full duty. In a population of active duty males, arthroscopic repair of isolated Type II SLAP had comparable results with a cohort of Type II SLAP repairs treated in combination with other shoulder conditions, with the combined treatment group having significantly better results in two of three parameters measured. Return to duty rates were identical. Therefore, concurrent treatment of other associated extra-articular shoulder conditions improves the overall success of SLAP repair and the presence of these other conditions should be recognized and treated along with the SLAP tears in order to maximize clinical results.

Arthroscopic superior labrum anterior-posterior repair in military patients

The purpose of this retrospective study was to determine the efficacy of arthroscopic superior labrum anterior-posterior (SLAP) repair in a military population. In this study, 27 patients (of 30 consecutive patients) who had suture anchor repair of a type II SLAP lesion were evaluated at a mean of 30.5 months postoperatively. Fifteen patients had isolated tears, whereas twelve also had a concomitant diagnosis. At follow-up, the overall mean American Shoulder and Elbow Surgeons score was 86.9 points and the mean University of California, Los Angeles score was 30.4 points. The results were excellent in 4 patients, good in 20, and fair in 3. Of the patients, 96% returned to full duty (mean, 4.4 months). Patients treated for concomitant diagnoses and a SLAP tear had significantly higher American Shoulder and Elbow Surgeons scores and tended to have higher University of California, Los Angeles scores than those treated for an isolated SLAP tear. The findings indicate that arthroscopic SLAP repair in military patients results in a high rate of return to duty. The results suggest that concomitant shoulder pathology should be treated at the time of SLAP repair.

Shoulder injuries in tennis players

The mechanism of the overhead action in throwing sports has been studied extensively. This motion is unnatural and highly dynamic, often exceeding the physiological limits of the joint. Owing to overload of various anatomical structures, the shoulder is susceptible to injury. Optimal shoulder function requires good kinetic chain function, optimal stability, and coordination of the scapula in the overhead action. A well balanced action of the rotator cuff muscles and capsular structures is necessary to obtain a stable centre of rotation during the overhead action. This review concerns shoulder injuries, related to the overhead motion in tennis players, which can be explained by the same mechanism as thrower's shoulder.

Arthroscopic transtendon repair of partial-thickness articular-side tears of the rotator cuff: anatomical and clinical study

BACKGROUND

The precise results of arthroscopic transtendon repair of partial-thickness articular-side tears of the rotator cuff remain to be reported.

HYPOTHESIS

Arthroscopic transtendon repair is useful in patients with Ellman grade 3 (>6 mm) partial-thickness articular-side tears of the supraspinatus tendon.

STUDY DESIGN

Descriptive laboratory study and case series; Level of evidence, 4.

METHODS

In 43 cadaveric shoulders (mean age, 80 years; range, 50-97 years), the authors measured the width of the supraspinatus insertion (medial-to-lateral direction) and the distance between the articular cartilage edge and the tendon insertion at a site 10 mm lateral to the anterior margin of the greater tuberosity. A clinical study group of 17 patients (mean age, 42 years; range, 17-51 years) was observed for a mean follow-up of 39 months (range, 25-57 months). University of California at Los Angeles and Japanese Orthopaedic Association shoulder scores and postoperative overhead athletic activities were evaluated.

RESULTS

The mean width of the supraspinatus insertion was 9.6 mm (SD, 1.6 mm; range, 7-13 mm; 95% confidence interval, 9.1-10.1 mm; 95% prediction interval, 6.4-12.8 mm). The mean distance between the articular cartilage edge and the tendon insertion was 0.3 mm (range, 0-2 mm). After the procedure, the mean University of California at Los Angeles and Japanese Orthopaedic Association scores significantly improved from 17.3 and 68.4 points to 32.9 and 94.8 points, respectively (P < .01). Rated on the Japanese Orthopaedic Association scale, results were excellent in 14, good in 2, and fair in 1 patient; there were no poor results. Of 6 overhead-throwing athletes, 2 returned to their previous sports at the same level, 3 returned at a lower level, and 1 was unable to return.

CONCLUSION

Arthroscopic transtendon repair is a safe, reliable procedure in patients with grade 3 partial-thickness articular-side tears. In the majority of patients, partial tears of more than 6 mm of the supraspinatus tendon thickness involved more than 50% of the entire tendon thickness.