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Tomasz Poboży

Partial-Thickness Rotator Cuff Tears — New ESSKA-ESA Consensus

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Tomasz Poboży

A new formal ESSKA-ESA consensus clarifies how partial-thickness posterosuperior rotator cuff tears should be described and assessed. The most practical message is that these lesions should not be reduced to a single percentage of tendon thickness or one classification. The report should reflect location, depth and the tendon involved, while also distinguishing acute from chronic tears. At the same time, the document makes clear where evidence is still weak — particularly for natural progression and the choice of the best imaging test.

Polish version: Częściowe uszkodzenia stożka rotatorów — nowy konsensus

Why is this consensus useful?

Partial-thickness rotator cuff tears are common, but their clinical significance is often difficult to judge. In practice, it is easy to place too much weight on one ultrasound or MRI measurement of tear depth even though treatment decisions also depend on the lesion’s location, mechanism, tendon involvement, symptoms and the patient’s functional demands.

The consensus from the European Society of Sports Traumatology, Knee Surgery and Arthroscopy and the European Shoulder Associates, published on 7 September 2026, addresses this part of the problem: definitions, classification, aetiology, natural history and diagnosis of partial-thickness posterosuperior rotator cuff tears.

Methodology

The steering group formulated 33 clinical questions, followed by a standardized literature search and evidence assessment. Statements were developed for each question with recommendation grades ranging from A to D, and an independent expert panel assessed them until strong consensus was reached.

This distinction matters. The publication is not a narrative review or an informal collection of expert opinions, but a formal consensus developed using a predefined ESSKA methodology. Its strength nevertheless remains constrained by the quality of the underlying evidence, which is limited in several areas.

Key findings

  • One classification is not enough. The strongest recommendations support combining descriptive systems so that location, depth and involvement of individual tendons are captured.
  • Acute and chronic tears should be distinguished. This also received a high-grade recommendation and directly affects interpretation and management.
  • Articular-sided lesions are more common in overhead and contact athletes. The evidence supporting this finding was weaker than the evidence behind the core classification recommendations.
  • No association was demonstrated between partial-thickness posterosuperior cuff tears and calcific tendinopathy.
  • Natural history remains difficult to predict. Evidence on the risk and rate of progression is less robust.
  • There is no single ideal imaging test. The consensus highlights limitations of current modalities in fully characterising these lesions.

Clinical interpretation for an orthopaedic surgeon

The most useful practical message concerns how these tears are described. A statement such as “50% tendon thickness tear” does not define the whole problem. Two lesions with similar depth may have different locations, mechanisms and tendon involvement, and may occur in patients with very different functional requirements.

The second point concerns imaging. Both ultrasound and MRI can be highly useful, but this consensus does not support treating any single examination as an infallible map of the lesion. Imaging should be interpreted together with the history and clinical examination. This is particularly important in partial-thickness abnormalities, where the distinction between tendinopathy, delamination and a true fibre defect may be less clear than in a large full-thickness tear.

Limitations

  • This is a formal consensus, not a randomized trial comparing treatment strategies.
  • Some recommendations rely on lower-quality evidence, particularly those concerning natural progression and optimal imaging.
  • The document addresses partial-thickness tears of the posterosuperior cuff, so its conclusions should not automatically be applied to every type of rotator cuff lesion.
  • This first part of the consensus focuses on definitions, classification, aetiology, natural history and diagnosis; it is not a ready-made algorithm for deciding who should undergo surgery.
  • The authors label the publication “Level I, formal consensus”. This should not be equated with the evidence level of a well-conducted randomized trial evaluating treatment efficacy.

What may change in practice — and what does the consensus not prove?

The document may improve communication between radiologists, musculoskeletal ultrasonographers and shoulder surgeons. A report of a partial-thickness tear should ideally provide more than a percentage estimate: location, extent, tendon involvement and whether the lesion appears acute or chronic all add useful clinical context.

The consensus does not show that a particular percentage of tendon involvement automatically requires surgery, that one imaging modality is always superior to the others, or that progression can be predicted reliably in an individual patient. Better prospective evidence is still needed in these areas.

Reference

Kany J, Ruiz Iban MA, Rosso C, et al. The 2026 ESSKA-ESA formal consensus on partial-thickness posterosuperior rotator cuff tears (Part 1): Definitions, classifications, etiologies, natural history and diagnosis. Knee Surgery, Sports Traumatology, Arthroscopy. Published online 7 September 2026. DOI: 10.1002/ksa.70587. PMID: 42704696.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.

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