Objective <p>To compare the clinical efficacy of arthroscopic tension-free transtendon repair versus conventional transtendon repair for partial articular-sided supraspinatus tendon avulsion (PASTA) lesions.</p> Methods <p>A retrospective analysis was performed on 42 patients who underwent arthroscopic PASTA repair at Fujian Hospital of Shanghai Sixth People’s Hospital between January 2023 and June 2024 and met the inclusion and exclusion criteria. The patients were divided into an experimental group (tension-free transtendon repair, <i>n</i> = 20) and a control group (conventional transtendon repair, <i>n</i> = 22). In the control group, after routine exploration and debridement of the partial articular-sided rotator cuff tear, the PASTA lesion was localized using a spinal needle. Following subacromial bursectomy and acromioplasty, a suture anchor was implanted directly into the footprint at the center of the PASTA lesion, and the rotator cuff was sutured using a spinal needle passed percutaneously through the tendon; the sutures from the anchor were then fixed with a knotless lateral anchor. In the experimental group, based on the same procedure as the control group, an additional high-strength suture was introduced using a spinal needle approximately 1&#xa0;cm medial to the PASTA lesion at the normal rotator cuff tissue. Both ends of this suture were passed through the bursal side of the rotator cuff, with the anteroposterior distance between the two ends exceeding that of the PASTA tear. Subsequently, both the sutures from the anchor and the high-strength suture were fixed with a knotless lateral anchor. Before final fixation of the lateral anchor, the tension of the high-strength suture was ensured to be slightly greater than that of the sutures from the anchor, thereby achieving tension-free repair of the PASTA lesion.</p> Results <p>The mean follow-up period was 13.2 ± 1.5 months (range, 12–14 months) in the experimental group and 13.5 ± 1.8 months (range, 12–15 months) in the control group. The postoperative Constant-Murley Score (CMS) in the control group (90.4 ± 2.6) was significantly improved compared with the preoperative score (50.5 ± 11.5) (<i>P</i> &lt; .001). The postoperative CMS in the experimental group (92.9 ± 2.4) was also significantly improved compared with the preoperative score (49.7 ± 8.2) (<i>P</i> &lt; .001). No statistically significant differences were observed between the two groups in preoperative CMS, preoperative CMS pain score, or postoperative CMS pain score (<i>P</i> &gt; .05). However, the difference in postoperative CMS between the two groups reached statistical significance (<i>P</i> &lt; .01), favoring the experimental group.</p> Conclusion <p>Arthroscopic tension-free transtendon repair may offer a modest functional advantage over conventional transtendon repair for PASTA lesions, though the clinical significance of this difference remains uncertain. These findings are preliminary and require validation in larger, prospective, randomized studies.</p>