Arthroscopic and Mini-open Rotator Cuff Repair Yield Comparable Clinical and Structural Outcomes in Small to Medium full-thickness tears: A Systematic Review and Meta-analysis of Randomized Controlled Trials Importance.
IMPORTANCE Arthroscopic (ARR) and mini-open (MRR) rotator cuff repair are both widely used, but whether ARR offers clinical advantages over MRR remains uncertain. OBJECTIVE To compare the clinical and structural outcomes of ARR and MRR in adult patients with rotator cuff tears. EVIDENCE REVIEW A systematic search of PubMed, Scopus, and the Cochrane Library was performed from inception to November 2025 for randomized controlled trials directly reporting functional score, shoulder range of motion (ROM), re-tear rate, pain, or complications with a minimum follow-up of 6 months. Random-effects models pooled standardized mean differences (SMDs) for functional scores; mean differences (MDs) for ROM and pain; and risk ratios (RRs) for dichotomous outcomes, each with 95% confidence intervals (CIs). FINDINGS Seven studies (725 shoulders) were included, predominantly involving small to medium sized full-thickness tears. Functional outcomes did not differ between ARR and MRR at 3, 6, or 12 months (SMD range, -0.26 to 0.33; p ≥ 0.53). Pain measured using the visual analog scale was comparable at 3 and 6 months, with minimal between-group differences (MD<0.1 points; p ≥ 0.82). Range of motion was also comparable at 6 and 12 months for both forward flexion and external rotation, with small pooled differences (MD<2°; p ≥ 0.18). There were no statistically significant differences in re-tear rates (RR 1.28, 95% CI 0.87 to 1.86, p=0.21), postoperative stiffness (RR 0.86, 95% CI 0.47 to 1.60, p=0.64), or infection (RR 0.19, 95% CI 0.02 to 1.59, p=0.12). CONCLUSION AND RELEVANCE ARR and MRR yielded comparable functional recovery, pain relief, structural integrity, and complication rates. Current evidence does not support the superiority of either technique. Technique selection should be individualized to tear characteristics, surgeon expertise, and resource availability. LEVEL OF EVIDENCE Level of evidence I-II, systematic review and meta-analysis of randomized controlled trials (RCTs).