Transtendinous repair of partial articular sided supraspinatus tears is associated with higher rates of stiffness and significantly inferior early functional scores than tear completion and repair: a systematic review

Introduction: Transtendon repair (TTR) and tear completion and repair (TCR) are common repair techniques for partial thickness rotator cuff tears (PTRCTs). Previous systematic reviews have not demonstrated any advantage of either but have not specifically addressed early recovery. Aim: To compare the outcomes of these two techniques in treating PTRCTs with respect to post-operative stiffness, delay in functional recovery and re-tear rates. Material and methods: A systematic review of the Medline and EMBASE database was performed in accordance with the PRISMA guidelines. Both cases series and comparative studies reporting functional outcomes, post-operative stiffness or re-tear rate after either TTR or TCR for PTRCTs were included. Results: The search strategy identified 21 studies (n = 797); 4 comparative studies (n = 214), 15 TTR (n = 511) and 2 TCR case series (n = 72). All four comparative studies included were randomised controlled trials. One RCT reported early outcomes and demonstrated significantly slower recovery in the TTR group at 3 months (ASES p = 0.037, Constant score p = 0.019 and pain p = 0.001). Similarly, data from the case series suggested that the rate of post-operative stiffness was higher in the TTR group. All comparative studies demonstrated no significant difference at final follow up in terms of pain, range of motion or functional score. Discussion: The results of this systematic review suggest that transtendinous repairs are associated with more pain and worse function during the first 3 months. This suggests that tear completion and repair should be the preferred option, as comparative studies do not demonstrate any long-term advantage of transtendinous repair. Type of study: Systematic review Level of proof: Level II evidence