Abstract
Background Intratendinous lesions of the rotator cuff of the shoulder are frequent and may be
a distinct clinical entity. Nevertheless, there are only a few publications which
deal specifically with this subject. This study analyses the existing literature for
the arthroscopic reconstruction of the intratendinous lesion of the supraspinatus
tendon, by means of a systematic review, and identifies relevant research questions
for future studies.
Material and Methods In January 2017, a systematic review of the U. S. National Library of Medicine/National
Institutes of Health (PubMed) Database and the Cochrane Library was conducted using
the PRISMA checklist. The search words were “supraspinatus” and “interstitial”; “supraspinatus”,
“tear” and “intratendinous”; “supraspinatus” and “concealed”. In the course of the
review, articles written in English with at least a partial arthroscopic case series
dealing with the reconstruction of the supraspinatus tendon were identified and further
analysed.
Results Primarily 70 hits could be generated. Five articles met the inclusion criteria and
were analysed in detail. The number of arthroscopic cases ranged between 6 and 33.
Level of evidence was IV in all studies. The diagnosis of an intratendinous lesion
was made by MR imaging when T2/fat-saturated sequences showed an intratendinous high
intensity signal without disruption of the bursal or articular layer. Three different
concepts were followed in surgical treatment: opening of the intratendinous lesion
from the bursal or articular side or by complete resection of the lesion. The reconstruction
was performed with suture anchors in all cases. In the majority of cases, an acromioplasty
was also performed. The reported clinical results were mostly good. Healing of the
tendon was shown by MR imaging in 81.5 to 100% of cases.
Conclusion After failure of conservative treatment, symptomatic intratendinous lesions of the
supraspinatus tendon can be localised intraoperatively and reconstructed after failure
of conservative treatment. The expected results are good in the medium term. The evidence
level of the studies analysed was low. Future studies should examine the role of alternative
conservative and surgical therapies.
Key words
supraspinatus tendon - intratendinous lesion - repair - arthroscopic - systematic
review
