No Clear Winner: A Study Finds Both Arthroscopic and Mini-Open Rotator Cuff Repairs Deliver Similar Results

Dr. (Prof.) Raju Vaishya, the lead author, explained that the findings are significant given the persistent perception that less invasive procedures yield superior results. "Despite the variation in surgical invasiveness, the study found comparable efficacy between the two techniques regarding Patient-Reported Outcome Measures (PROMs). This comprehensive review aims to settle the long-standing debate regarding the superiority of the all-arthroscopic approach,” he told Medical Dialogues. 

The research team conducted a systematic review in line with the Cochrane Handbook, examining meta-analyses that reported on outcomes from adult patients undergoing either ASR or MOR. Databases such as PubMed, Scopus, and Google Scholar were screened to identify eligible studies. The included analyses covered key functional scores—Constant-Murley, UCLA, and ASES—along with pain levels assessed through VAS, range of motion, operative time, and postoperative complications such as retear rates or adhesive capsulitis.

Key Findings:

• Eight meta-analyses were included, evaluating an average of 995 procedures divided almost equally between arthroscopic and mini-open repairs.
• No significant differences were observed in Constant-Murley scores, ASES scores, VAS pain scores, range of motion outcomes, retear rates, or rates of adhesive capsulitis.
• Arthroscopic repair showed a slight benefit in UCLA scores.
• Mini-open repair consistently resulted in shorter operative times.

Co-author Prof. Filippo Migliorini (Italy) emphasized the strength of synthesizing outcomes across multiple high-quality meta-analyses. “By pooling data from multiple robust reviews, the team was able to generate Grade 1 evidence. This structure helped eliminate the noise often seen in smaller studies, offering a clearer picture of postoperative recovery. The findings suggest that the choice of technique may be less critical than previously believed when it comes to long-term patient satisfaction,” he noted.

Commenting on the clinical metrics, co-author Dr. Abhishek Vaish (Consultant at Indrapastha Apollo Hospitals, New Delhi) added that the commonly used functional assessments aligned closely between both groups. "Scores such as the ASES and Constant scores showed no clinically significant difference between the two cohorts. While arthroscopy is often preferred for cosmetic appeal, the mini-open technique remains a dependable and clinically equivalent option for restoring shoulder function and reducing pain,” he explained.

Highlighting the practical implications for surgeons, Dr. Vaishya highlighted the need for flexibility in tailoring treatment plans. “Since clinical outcomes are equivalent, the decision should be guided by surgeon proficiency, cost-effectiveness, and specific tear characteristics rather than a perceived functional advantage of one method over the other. This overview offers important evidence base for orthopedic surgeons counseling patients on expected recovery pathways,” he said.

The authors note that further high-quality trials with imaging data and long-term follow-up would help refine surgical decision-making, but the current evidence strongly supports both ASR and MOR as reliable options for rotator cuff repair.

Reference:

Vaishya, R., Saiyed, A., Patralekh, M. K., Vaish, A., & Migliorini, F. (2025). Patient-reported outcomes (PROMs) of arthroscopic versus mini-open rotator cuff repair- an overview of meta-analysis. Journal of Orthopaedics. https://doi.org/10.1016/j.jor.2025.11.035