Transtendon repair vs. tear completion in partial-thickness rotator cuff tears: systematic review and meta-analysis

Background: Partial-thickness rotator cuff tears (PTRCTs) are common and present a treatment dilemma between preserving the intact tendon with transtendon repair or converting the lesion to a full-thickness tear before repair. Comparative evidence on clinical outcomes and retear rates lacks consensus regarding the optimal treatment of PTRCTs. Therefore, we aimed to systematically compare functional outcomes and tendon integrity following transtendon vs. tear completion repair for PTRCTs. Methods: A systematic search of PubMed and Scopus was conducted from inception to May 2025. Studies directly comparing the 2 surgical approaches and reporting post-operative functional scores (Constant-Murley, American Shoulder and Elbow Surgeons [ASES], visual analog scale) or imaging-confirmed tendon integrity were included. Pooled mean differences (MDs) and odds ratios were calculated using random-effects models. Risk of bias was assessed with the Newcastle-Ottawa Scale and the Cochrane risk of bias tool. Results: Nine studies (3 randomized trials, 6 observational; 719 patients-336 transtendon, 385 tear completion repairs) were included. Pooled analysis demonstrated no significant differences between the techniques for Constant-Murley (MD: -0.79, 95% confidence interval [CI]: -1.71 to 0.12; P = .09), ASES (MD: -1.04, 95% CI: -3.90 to 1.83; P = .48), or visual analog scale (MD: 0.11, 95% CI: -0.03 to 0.26; P = .11). Retear rates were also similar (odds ratio: 0.97, 95% CI: 0.39-2.44; P = .96). Subgroup analysis showed no advantage for either technique in articular-sided tears in Constant score (MD: -0.79; 95% CI: -2.47 to 0.88; P = .56) and ASES score (MD: 1.2; 95% CI: -1.21 to 3.61). For bursal-sided tears, tear completion yielded higher Constant-Murley scores (MD: -1.08; 95% CI: -1.88 to -0.28; P = .007). Discussion: This meta-analysis found no clinically meaningful difference between transtendon and tear completion repair in terms of shoulder function or tendon healing. Surgical choice should be individualized according to tear characteristics, intraoperative findings, and surgeon expertise.