The management of partial-thickness rotator cuff tears (PTRCTs) has long been considered a gray area in orthopedics. Unlike full-thickness tears, where the tendon completely detaches from the bone, partial tears involve fraying or tearing of only a portion of the tendon fibers.
Non-operative treatment — including physical therapy, injections, and activity modification — remains the first line of care. However, when pain persists and function declines, surgical repair may offer meaningful benefit. Here’s what the evidence tells us.
Partial-thickness rotator cuff tears are typically classified by location:
Articular-sided tears
These occur on the underside of the tendon (facing the joint). They are more common and often associated with internal impingement.
Bursal-sided tears
These occur on the top side of the tendon. They are often considered more clinically significant because they lack the natural healing potential seen in some articular-sided tears.
Understanding the tear location helps guide treatment decisions.
One of the strongest arguments for repair is preventing progression.
Many surgeons apply the “50% rule.” When more than 50% of the tendon thickness is torn, the remaining fibers experience significantly increased mechanical stress. This increases the likelihood of progression to a full-thickness tear.
Serial MRI studies suggest that more than 40% of symptomatic partial tears enlarge within two years if left untreated.
Repair in high-grade tears can help protect the remaining tendon and preserve long-term shoulder integrity.
Physical therapy is highly effective at improving range of motion and strengthening surrounding musculature. However, therapy cannot anatomically heal a mechanical tear.
For patients who have plateaued after 3–6 months of conservative management, surgical repair — whether through debridement (for smaller tears) or in situ repair — has demonstrated statistically significant improvements in pain scores (VAS).
When pain persists despite appropriate non-operative care, surgical intervention can provide meaningful relief.
Modern techniques, including transtendon repair, allow surgeons to repair the torn portion without detaching the remaining healthy fibers.
This approach:
• Preserves the natural “cable” system of the shoulder
• Reinforces weakened tendon fibers
• Restores the tendon footprint (where tendon meets bone)
• Improves torque production and strength
The goal is not just pain reduction — but restoration of proper biomechanics.
Partial-thickness tear repairs often recover more quickly than full-thickness repairs.
In many cases:
• Sling use may be limited
• Early range of motion can begin quickly
• Full motion is often regained within a month
• Overhead strength can return within several months
Because the tendon is not completely detached, rehabilitation is typically more accelerated.
Debridement (Cleaning the Tear)
• Typically used for tears involving less than 50% thickness
• Faster initial rehabilitation
• Higher risk of long-term progression
Formal Repair (Suturing the Tear)
• Generally recommended when more than 50% thickness is involved
• Slightly longer early recovery than debridement
• Lower long-term failure rates
• Better outcomes for active or younger patients
Treatment decisions are individualized based on tear size, location, patient age, activity level, and goals.
Current orthopedic literature suggests that surgical repair offers the greatest benefit in:
• Bursal-sided tears
• Articular tears exceeding 50% thickness
• Symptomatic patients who have failed conservative care
In these patients, operative repair is associated with high patient satisfaction scores (ASES and Constant scores) and reliable return to activity.
Clinical Pearl:
Don’t wait for a partial tear to become a full-thickness defect. When symptoms persist and imaging shows a high-grade tear, repair isn’t just about relieving pain — it’s about protecting the long-term integrity of the shoulder.
