AANA Lab Course 906- Técnicas Avanzadas de Cirugía de Hombro-Cómo manejar las roturas parciales del manguito rotador_ desbridamiento, conversion en rotura de espesor complete o reparación transtendinosa

Cómo manejar las roturas parciales del manguito rotador_ desbridamiento, conversion en rotura de espesor complete o reparación transtendinosa_-Mauricio Largacha, MD

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This presentation by Mauricio Largacha (2019) discusses partial rotator cuff tears, focusing on clinical spectrum, pathology, classification, treatment options, and outcomes.<br /><br />Key Points:<br />- Partial rotator cuff tears present a range of clinical symptoms that correlate with size and may overlap with other shoulder pathologies. Understanding has improved over time.<br />- Questions addressed include when to operate, debride, fix the tear, and the role of acromioplasty.<br />- Tears are classified as intraarticular, bursally located, or intratendinous, with further detail on tendon insertion sites (supraspinatus and infraspinatus) drawn from Sugaya’s studies.<br /><br />Treatment Options:<br />1. Debridement:<br />   - Shows good short-term outcomes but tends to deteriorate by 5 years.<br />   - High rates of labral pathology and conversion to total repairs.<br />   - Bursal tears have worse prognoses.<br />2. Debridement with subacromial decompression:<br />   - Also yields short-term benefits with less deterioration.<br />   - No documented tendon healing; about 50% poor results.<br />   - Around half of athletes return to sport.<br />3. Repair:<br />   - Repairs have better long-term results than debridement alone.<br />   - Arthroscopic techniques are improving, but re-rupture rates vary (25-75% depending on athlete status).<br />   - “Close-the-flap” and transtendinous repairs are common techniques.<br />   - Completing partial tears into total tears is often necessary.<br />   - Athletes have better repair success rates compared to non-athletes.<br /><br />The author suggests if the goal is to have an athlete return to competitive performance (e.g., appear on television), non-fixation is advised, implying that repair may compromise this.<br /><br />In summary, treatment decisions for partial rotator cuff tears should consider tear type, patient activity level, and realistic expectations regarding outcomes. Debridement serves short-term relief but may lead to deterioration, especially in bursally located tears, while repair offers better long-term durability, particularly in athletes.

Asset Caption

(How to Manage Partial Thickness Rotator Cuff Tears: Debridement, Takedown or Repair?)

Keywords

partial rotator cuff tears

clinical spectrum

tear classification

treatment options

debridement

subacromial decompression

arthroscopic repair

athlete outcomes

tear location

long-term prognosis