Arthroscopic versus Open Repair for Rotator Cuff Tears: A Systematic Review and Meta-Analysis of Functional Outcomes, Retear Rates, and Complications

Sachin N C; Tejal V V; Vedavathi H

doi:10.51168/dqkskm92

Authors

Dr. Sachin N C Senior Registar, Apollo Hospital, Bannerghatta Road , Bangalore -560076, Karnataka, India
Dr. Tejal.V V Resident, Indira Maternity and Skin Laser Center, Station Road, Tumkur- 572102, Karnataka, India
Dr. Vedavathi H Professor and Head, Department of Pharmacology, Shimoga Institute of Medical Sciences, Shimoga 577201, Karnataka, India

DOI:

https://doi.org/10.51168/dqkskm92

Keywords:

arthroscopy, open repair, mini-open repair, meta-analysis, retear, rotator cuff tear, shoulder function, tendon healing

Abstract

Background: Rotator cuff repair is increasingly performed arthroscopically, but its comparative advantages over conventional open and mini-open repair remain uncertain.

Objective: To compare functional outcomes, structural retear, pain, range of motion, and complications after arthroscopic versus open or mini-open rotator cuff repair.

Methods: MEDLINE/PubMed, the Cochrane Library, trial registries, reference lists, and citation searches were searched from inception through 31 December 2025. Randomised and non-randomised comparative studies of adults undergoing primary repair were eligible. Conventional open and mini-open procedures were analysed separately. To avoid double-counting, the most complete outcome-specific pooled estimates from overlapping evidence syntheses were retained. Risk of bias and certainty were evaluated using RoB 2 or ROBINS-I domains and GRADE principles.

Results: Thirty-three comparative studies were identified: six randomised trials and 27 cohorts. Long-term function was generally comparable. Pooled estimates showed no important difference in ASES score (SMD 0.14, 95% CI -0.07 to 0.34; I²=0%) or DASH score (SMD -0.01, 95% CI -0.28 to 0.25; I²=0%). A reported Constant-Murley advantage for mini-open repair (SMD 0.87, 95% CI 0.11 to 1.62) was heterogeneous (I²=81%). Pain differences through 12 months were below clinical-importance thresholds. A retear advantage for mini-open repair (odds ratio 0.48, 95% CI 0.25 to 0.92; I²=0%) disappeared in double-row comparisons. Arthroscopy yielded faster early pain and motion recovery, whereas infection, stiffness, revision, and long-term healing were similar.

Conclusion: Arthroscopic and open or mini-open repair provide broadly comparable medium- and long-term outcomes. Arthroscopy may accelerate early recovery, but clinically meaningful long-term superiority is unproven. Technique selection should consider tear morphology, tissue quality, fixation, surgeon expertise, and resources.

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