Transosseous physeal-sparing rotator cuff repair in an adolescent football player

Rotator cuff injuries in the pediatric and adolescent population are rare. These injuries are normally caused by an acute event or by repeated microtrauma as a result of poor mechanics during overhead sporting activities. Overall, these injuries account for fewer than 1% of all rotator cuff tears. Physeal injuries, tuberosity avulsions ("rotator cuff equivalents"), and proximal humeral fractures commonly occur in the pediatric population. Traumatic full-thickness rotator cuff ruptures that occur in this age group during contact sports are an extremely uncommon cause of shoulder pain. The rarity of this type of injury in the pediatric and adolescent population may be the result of the excellent tensile properties of rotator tendons in childhood that often resist mechanical forces better than the growth plate or the apophyses. This report describes a full-thickness rotator cuff tear and a posterior labral tear in a 12-year-old boy who had a direct injury to the shoulder while playing football. The authors' goal in reporting this case is to increase orthopedic surgeons' awareness of this type of injury. Early use of magnetic resonance imaging for persistent shoulder pain after direct injury during contact sports may avoid undue delay in diagnosis. This report also describes the mini-open transosseous extraphyseal technique of cuff repair and reviews the literature on this infrequent injury. Overall, excellent clinical outcomes and return to sports can be expected after surgical repair of torn and often retracted tendons.