The 2026 ESSKA-ESA formal consensus on partial-thickness posterosuperior rotator cuff tears (Part 2): Treatment strategies, rehabilitation, return to sport and complications

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.