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.

Abstract

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.