Arthroscopic anatomic complete versus non-anatomic repair of massive rotator cuff tears: a systematic review of comparative trials

Several clinical studies have compared the clinical and functional outcomes of arthroscopic anatomic complete repair and arthroscopic partial repair for massive rotator cuff tears (MRCTs). To our knowledge, no systematic review of these comparative trials has been published yet. A systematic analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. Six studies were eligible for analysis, and they were level III case–control studies. There were 223 cases of complete repair and 208 cases of partial repair (mean age range 59–67 years, mean follow-up range 24–45 months). All studies reported significant postoperative improvement in the reported subjective scores and range of motion in both groups. Complete repair was associated with at least equal or better functional outcomes compared to the partial repair. The rate of complications requiring reoperation in the complete and partial repair cohorts was 1.3% and 3.4%, respectively. Although the overall rate of radiographic integrity of the complete and partial repair cohorts was 61.1% and 26.7%, respectively, we found no clinical relevance in this finding. There is moderate-to-good quality evidence to support that both arthroscopic complete and partial repairs of MRCTs are associated with satisfactory functional outcomes and low rate of complications requiring reoperation. Complete repair is associated with at least equal or better functional outcomes compared to the partial repair and, therefore, it should remain the first line of treatment.