Intratendinous rupture of the supraspinatus: anatomical and functional results of 24 operative cases.

INTRODUCTION: The aim was to describe the natural history of intratendinous partial rotator cuff tears as well as the anatomical and clinical results of surgical treatment of a cohort of 24 patients.

PATIENTS AND METHODS: There were 14 men and 10 women with a mean age of 50 years. The right shoulder was involved in 17 cases. For 16 cases, a progressive history of shoulder pain was reported. Pre-operatively, a painful and positive Jobe's sign was observed in only 13 cases. Pre-operative mean absolute constant score was 63.52 points. Based on standard MRI, intratendinous lesions were diagnosed on the coronal view with hyper-signal within the tendon in the T2 FatSat sequence. No fatty infiltration was noted. Fourteen open and 10 arthroscopic repairs were performed.

RESULTS: Patients were reviewed with clinical assessment and MRI. The final Constant score was 81.3 points with a mean gain of 18.5 points. Patients were back to work after a mean of 5.8 months and to sports after 6 months. The mean subjective result was of 8.9/10. Three cases of reflex sympathetic dystrophy were observed.

DISCUSSION: Intratendinous tears of the supraspinatus tendon are rare and difficult to diagnose. Diagnosis relies on MRI (T2 FatSat). Trauma is not usually described. Chronic calcifying tendonitis may also contribute to the development of such tears. There is no associated fatty infiltration of the muscle. The Jobe's test is frequently painful or positive. Arthroscopic resection of the tendon insertion with reinsertion to the greater tuberosity seems to be the optimal treatment.

LEVEL OF EVIDENCE: Retrospective study, IV.