Title : Functional outcomes of arthroscopic versus open/mini-open repair in full-thickness Rotator Cuff Tears (RCTs): A systematic review of contemporary comparative evidence
Abstract:
Background: The optimal surgical approach for full-thickness Rotator Cuff Tears (RCTs) remains a subject of debate. While arthroscopic repair (aRCR) offers theoretical benefits in deltoid preservation and visualization, open/mini-open repair (oRCR) historically provided reliable fixation. This systematic review synthesizes contemporary evidence comparing functional and structural outcomes between these techniques.
Methods: Following PRISMA 2020 guidelines, PubMed, Embase, Cochrane, and Scopus were searched for comparative studies published between 2016 and 2026. The primary outcome was the Constant-Murley Score (CMS). Secondary outcomes included ASES and UCLA scores, imaging-confirmed re-tear rates, and complications.
Results: Six studies (3 RCTs, 3 cohorts) involving 684 patients were included. Both techniques yielded statistically and clinically significant improvements exceeding the Minimal Clinically Important Difference (MCID). Postoperative CMS ranged from 78–91 across groups with no significant between-group differences (p > 0.05). Re-tear rates were comparable (aRCR: 12-24% vs. oRCR: 10-22%). Tear size >3cm and Goutallier grade of fatty infiltration were stronger predictors of structural failure than surgical approach. Complication rates were low in both groups, with minor variations in wound morbidity (open) vs. transient stiffness (arthroscopic).
Conclusion: Both arthroscopic and open/mini-open repairs provide substantial functional restoration and comparable structural integrity for full-thickness RCTs. Surgeon expertise and patient-specific factors, rather than surgical exposure, are the primary drivers of clinical success.
Level of Evidence: Level II
