On a fixed refresh rate monitor, you can either run the game at the monitor’s native refresh rate (~60 Hz) with smooth sync/scrolling (RetroArch’s default settings), or you run the game at its native speed with tearing/stuttering (i.e., vsync OFF, audio sync ON; the ‘sync to exact content framerate’ also does this). There’s no other option.
With a variable refresh rate monitor, you can make your monitor sync at the same speed as the game (e.g., 55 Hz) to have smooth sync/scrolling, no tearing/stuttering and the proper speed (also ‘sync to exact content framerate’).