Patient-reported outcomes (PROMs) of arthroscopic versus mini-open rotator cuff repair-an overview of meta-analysis

Rotator cuff tears are a leading cause of shoulder pain and disability. While both arthroscopic repair (ASR) and mini-open rotator cuff repair (MOR) techniques are widely practised, evidence remains inconclusive regarding their relative clinical efficacy. This overview of meta-analyses aimed to compare patient-reported and functional outcomes between ASR and MOR.

A systematic overview of published meta-analyses was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Databases including PubMed, Scopus, and Google Scholar were searched using relevant keywords. Meta-analyses evaluating outcomes in adults undergoing ASR or MOR were included. Data extraction focused on functional scores (Constant-Murley, UCLA, ASES), pain (VAS), range of motion, surgical duration, and complications (retear rate, adhesive capsulitis). Statistical analyses were performed using RevMan 5.4 with random- or fixed-effects models depending on heterogeneity (I² threshold of 50 %).

Eight meta-analyses comprising a mean of 995.75 procedures (ASR: 533.5, MOR: 462.25) were included. No significant differences were observed between ASR and MOR for Constant-Murley Score (p = 0.70), ASES (p = 0.90), VAS (p = 1.0), range of motion, retear rate (p = 0.08), or adhesive capsulitis (p = 0.58). MOR demonstrated a significantly shorter operative time compared with ASR (p = 0.007). However, ASR demonstrated a higher UCLA score compared with MOR (p = 0.03).

Both arthroscopic and mini-open rotator cuff repair techniques yield comparable clinical and patient-reported outcomes. While the mini-open approach offers a shorter operative duration, the choice of technique should be guided primarily by surgeon expertise, tear characteristics, and patient-specific factors. Further high-quality studies incorporating imaging and long-term follow-up are warranted to optimise rotator cuff repair strategies.