Conservative Management Versus Arthroscopic Repair for Symptomatic Partial-Thickness Supraspinatus Tears: A Prospective Comparative Analytical Study

Introduction The optimal management of symptomatic partial-thickness rotator cuff tears (Ellman Grade II and III) remains controversial. While meta-analyses exist for full-thickness tears, prospective comparative data specifically for these intermediate lesions is limited. This study compared the functional outcomes of structured conservative rehabilitation versus arthroscopic repair to determine therapeutic efficacy. Methods A prospective comparative analytical study was conducted involving 50 patients with MRI-confirmed symptomatic partial-thickness supraspinatus tears. Patients were allocated to either conservative management (n=25) involving a supervised FITT-based rehabilitation protocol or arthroscopic repair (n=25) based on shared decision-making. Functional outcomes were assessed using the Constant-Murley Score (CMS) and Visual Analog Scale (VAS) at baseline, 1 month, and 6 months. Results Baseline characteristics were well-matched. At six months, both groups demonstrated significant functional improvement, with no statistically significant difference in final CMS (conservative: 75.7 ± 5.9 vs. surgical: 75.0 ± 6.7; p=0.723). The conservative group demonstrated a significant early functional advantage at 1 month (p<0.001) due to the avoidance of postoperative immobilization. While the surgical group achieved statistically lower absolute pain scores at 6 months (p=0.007), the mean difference (0.40 points) did not exceed the Minimal Clinically Important Difference (MCID). Conclusion Structured conservative management yields short-term functional outcomes equivalent to arthroscopic repair for symptomatic partial-thickness supraspinatus tears, with the added benefit of faster early recovery. These findings support conservative care as a robust first-line strategy. Limitations include the non-randomized design and short-term follow-up, necessitating future longitudinal research to assess tear progression.