Outcomes of partial vs. complete repair for large to massive rotator cuff tears: A systematic review and meta-analysis

Background 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. Methods This PRISMA-compliant systematic review screened MEDLINE, EMBASE, and, CENTRAL through June 15, 2025. Study quality was assessed using ROBINS-I. Included, studies involved patients with large (≥3 cm) or massive (≥5 cm, ≥2 tendons, or ≥30 cm 2 ) rotator, cuff tears, comparing arthroscopic partial versus complete repair and reporting at least one, clinical or functional outcome. Only comparative human studies published in English were; considered. Primary outcomes were postoperative range of motion and strength; secondary, outcomes included functional scores, acromiohumeral distance, structural failure rates, postoperative tear size, and postoperative pain score. Data were pooled using random-effects, meta-analysis with standardized mean differences (SMD) and odds ratios (OR) with 95%, confidence intervals (CI). Results Nine studies with 508 patients (220 partial, 288 complete repairs) met inclusion criteria. Complete repair demonstrated greater postoperative strength recovery (SMD = -0.363, 95% CI [-0.685, -0.042], p=0.027; I 2 = 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-reportedoutcomes were largely similar; ASES and SSV did not differ (I 2 = 0% for both), while Constant scores favored complete repair but with substantial heterogeneity (I 2 = 67.2%). Across studies that performed postoperative imaging, rates of imaging-defined structural failure/progression were similar, although imaging protocols and failure definitions varied. Conclusion 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 postoperative 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 implented. Accordingly, these findings should not be interpreted as evidence of equivalence between repair techniques in otherwise repairable tears.