KSSTA - 2026-09-21 - Journal Article
The 2026 ESSKA-ESA formal consensus on partial-thickness posterosuperior rotator cuff tears (Part 2): Treatment strategies, rehabilitation, return to sport and complications.
Kany J, Iban MR, Calvo E, Rosso C, Peach C, Dias CM, Métais P, Saccomanno MF, Bøe B, Brilakis E, Bilsel K, Kovacic L, Raebroeckx AV, Gomes N, Martetschläger F, Beaufils P, Dyrna F
Topics
Key Takeaway
Trans-tendon repair of articular-sided partial-thickness posterosuperior rotator cuff tears carries a Grade A evidence-supported increased risk of postoperative stiffness compared with tear-completion-and-repair, while both techniques yield similar return-to-sport rates.
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Summary
This ESSKA-ESA formal consensus addressed treatment, rehabilitation, return to sport, and complications for partial-thickness posterosuperior rotator cuff tears using a three-round Delphi-style process with 33 question-statement pairs. Twenty-one pairs achieved strong agreement, generating 30 recommendations spanning Grade A–D evidence. Key findings include Grade A evidence for increased stiffness with trans-tendon repair versus tear-completion-and-repair, Grade B support for ≥6 months of conservative treatment and PRP injections, and equivalent return-to-sport rates between surgical techniques despite slightly higher retear rates with tear-completion-and-repair.
Key Limitation
The overwhelming proportion of Grade C and D recommendations (23 of 30) reflects the paucity of high-quality RCT data on partial-thickness tears, limiting the actionability of most consensus statements.
Original Abstract
PURPOSE
To establish evidence-based consensus recommendations for the management of partial-thickness posterosuperior rotator cuff tears (PT-PS-RCTs). This second part addresses treatment strategies, rehabilitation, return to sport and complications.
METHODS
This European Society for Sports Traumatology, Knee Surgery and Arthroscopy-European Shoulder Associates (ESSKA-ESA) Formal Consensus was conducted according to the ESSKA Formal Consensus Methodology. A Steering Group (13 shoulder surgeons) developed 33 questions and statements based on a standardized literature review and assigned recommendation grades (A-D) according to the level of evidence. Statements were evaluated by an independent Rating Group (20 shoulder surgeons) through a three-round consensus process.
RESULTS
Twenty-one Question-Statement (Q-S) pairs achieved strong agreement, generating 30 individual recommendations (1 Grade A, 6 Grade B, 10 Grade C and 13 Grade D). Grade A evidence identified an increased risk of postoperative stiffness after trans-tendon repair of articular-sided PT-PS-RCTs compared with tear completion. Grade B evidence supported conservative treatment for at least 6 months, platelet-rich plasma injections and management of stiffness before surgery; both trans-tendon/in-situ repair and tear-completion-and-repair showed similar return-to-sport rates, although tear-completion-and-repair had slightly higher retear rates. The most commonly reported patient-reported outcome measures were the American Shoulder and Elbow Surgeons, Constant-Murley and visual analogue scale scores.
CONCLUSION
Management should be individualized according to patient characteristics (activity level, sports participation), symptoms, tear morphology and tissue quality rather than based on a single treatment algorithm. Non-surgical treatment is the preferred initial approach, whereas no surgical technique has demonstrated consistent superiority across all clinical scenarios. These recommendations provide clinicians with a practical framework to guide treatment decisions and standardize the management of PT-PS-RCTs in daily clinical practice.
LEVEL OF EVIDENCE
Level I, formal consensus.