Outcomes of partial vs. complete repair for large to massive rotator cuff tears: a systematic review and...

Large to massive rotator cuff tears are challenging to repair, with partial and complete techniques showing variable outcomes. The purpose of this study is to systematically compare clinical, functional, and structural outcomes following partial and complete repairs.

This Preferred Reporting Items for Systematic Reviews and Meta-Analyses‑compliant systematic review screened MEDLINE, Embase, and Cochrane Central Register of Controlled Trials through June 15, 2025. Study quality was assessed using Risk Of Bias In Non-randomized Studies of Interventions. Included studies involved patients with large (≥ 3 cm) or massive (≥ 5 cm, ≥ 2 tendons, or ≥ 30 cm²) rotator cuff tears, comparing arthroscopic partial vs. complete repair and reporting at least one clinical or functional outcome. Only comparative human studies published in English were considered. Primary outcomes were post-operative range of motion and strength; secondary outcomes included functional scores, acromiohumeral distance, structural failure rates, post-operative tear size, and post-operative pain score. Data were pooled using random-effects meta-analysis with standardized mean differences and odds ratios with 95% confidence intervals.

Nine studies with 508 patients (220 partial and 288 complete repairs) met inclusion criteria. Complete repair demonstrated greater post-operative strength recovery (standardized mean difference = -0.363, 95% confidence interval: [-0.685, 0.042], P = .027; I² = 0%). Forward flexion and internal rotation were comparable between groups with negligible heterogeneity (I² = 0% for both), whereas external rotation showed no difference but substantial heterogeneity (I² = 73.0%). Patient-reported outcomes were largely similar; American Shoulder and Elbow Surgeons and Subjective Shoulder Value did not differ (I² = 0% for both), while Constant scores favored complete repair but with substantial heterogeneity (I² = 67.2%). Across studies that performed post-operative imaging, rates of imaging-defined structural failure/progression were similar, although imaging protocols and failure definitions varied.

In comparative studies of large-to-massive rotator cuff tears, partial repair achieved clinical improvement comparable to complete repair across most patient-reported and range-of-motion outcomes. Complete repair showed modest but consistently superior outcomes in post-operative strength recovery, whereas differences in composite functional scores were less consistent and sensitive to between-study heterogeneity and tear-severity mix. Interpretation of these findings is further limited by tear characteristics and reparability which heavily influenced the repair strategy implemented. Accordingly, these findings should not be interpreted as evidence of equivalence between repair techniques in otherwise repairable tears.