Arthroscopic Repair of Bursal-Sided Partial-Thickness Rotator Cuff Tears: Literature Review and Meta-analysis

Background: The surgical management of bursal-sided partial-thickness rotator cuff tendon tears is controversial. The 2 methods used are in situ repair (ISR), preserving the contingent of intact articular tendon fiber, or tear completion before repair (TCBR) according to the operating surgeon's usual technique. No study with sufficient power has demonstrated a superior technique.

Hypothesis: The 2 techniques are equivalent in terms of clinical outcome and tendon healing.

Study design: Systematic literature review and meta-analysis; Level of evidence, 4.

Methods: A systematic review was carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations on the PubMed, Embase, and Cochrane Library databases from January 2003 through March 2023. Only articles dealing with Ellman grade 3 bursal-sided tears with a minimum follow-up of 1 year were included. Primary endpoints were American Shoulder and Elbow Surgeons and Constant-Murley scores, pain on a visual analog scale, and retear rate. The secondary endpoint was recovery of active mobility.

Results: Twelve studies were included with overlap of 3, leaving 8 ISR studies (360 patients; mean follow-up, 30 months) and 7 TCBR studies (224 patients; mean follow-up, 51 months) for statistical analysis. No significant clinical differences were found when comparing mean American Shoulder and Elbow Surgeons (92.2 [95% CI, 88.1-96.2] vs 88.9 [95% CI, 85.8-92.0]; P = .21), Constant-Murley (86.3 [95% CI, 81.5-91.0] vs 91.8 [95% CI, 88.1-95.6]; P = .07), and visual analog scale (0.8 [95% CI, 0.2-1.4] vs 1.0 [95% CI, 0.5-1.4]; P = .63) scores in the TCBR and ISR groups, respectively. The retear rate was 6.8% (95% CI, 3.1%-14.3%) in the TCBR group and 9.5% (95% CI, 6.1%-14.3%) in the ISR group (P = .46). Active mobility was also comparable.

Conclusion: This meta-analysis suggests that ISR and TCBR provide comparable results in the surgical management of Ellman grade 3 bursal-sided partial-thickness rotator cuff tears.