Surgical vs. non-surgical therapy for partial tears of the rotator cuff: a systematic review and meta-analysis of pooled studies with indirect comparison

Abstract Background Rotator cuff disease (RCD) constitutes the most common cause of shoulder pain, with partial-thickness rotator cuff tears (PT-RCTs) representing a substantial subset that may progress over time. Although both surgical and non-surgical interventions are employed in clinical practice, a consensus regarding the optimal management of symptomatic PT-RCTs is lacking, and a comprehensive synthesis of available evidence has not yet been conducted. Methods A systematic review was conducted according to PRISMA guidelines using MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, and WHO ICTRP. Studies on arthroscopic surgical and/or non-surgical treatments for PT-RCTs in patients ≥ 18 years were included. Clinical outcomes (Constant Score (CS), ASES Score, VAS for pain) were extracted. Random-effects meta-analysis and descriptive statistics were used to analyze outcomes and study characteristics. Results Of the 9,894 trials screened, 33 trials with a total of 1,818 patients met the inclusion criteria. Comparing pooled weighted mean outcomes across studies, surgical cohorts demonstrated higher scores than non-surgical cohorts in both the CS ( p = 0.0095) and the ASES ( p = 0.0060). However, no specific surgical technique proved superior, with neither Reconstruction versus Debridement (CS, p = 0.19; ASES, p = 0.06) nor Tear Completion versus Transtendon Repair (CS, p = 0.13; ASES, p = 0.65) reaching statistical significance. Although surgical treatment was statistically superior to non-surgical approaches, the observed differences remained below the minimal clinically important differences (MCID), indicating limited clinical relevance. Conclusion Pooled analyses showed higher Constant and ASES scores in surgical cohorts. However, the magnitude of this difference does not exceed MCID, indicating limited clinical relevance. No surgical technique demonstrated significant superiority. These findings highlight the need for individualized treatment decisions, considering the limited clinical benefit of surgery over non-surgical approaches. Protocol Registration The protocol was registered in PROSPERO with ID: CRD42023487714