Arthroscopic versus mini-open rotator cuff repair: A meta-analysis

Background: Mini-open and all-arthroscopic rotator cuff repairs are commonly performed, yet it remains uncertain whether one approach consistently outperforms the other. Methods: A comprehensive search of PubMed, Scopus, Cochrane, and Google Scholar through November 2025 identified 33 comparative studies (six RCTs and 27 cohort studies) including 1980 patients (mini-open: 980; arthroscopic: 1000). Extracted outcomes included operative time, shoulder ROM, functional scores, pain, satisfaction, re-tear rates, postoperative stiffness, and other complications. Results: Shoulder ROM demonstrated no significant differences between groups in forward flexion (p = 0.51), abduction (p = 0.48), internal rotation (p = 0.68), or external rotation (p = 0.11). Functional outcomes were likewise comparable for ASES (p = 0.16), Constant (p = 0.92), UCLA (p = 0.12), and DASH (p = 0.39). Arthroscopy was associated with slightly lower postoperative VAS pain scores (MD 0.28; p = 0.002). Satisfaction rates (p = 0.50), re-tear rates (p = 0.71), operative time (p = 0.15), and stiffness (p = 0.06) were similar. Complications such as infection, anchor issues, frozen shoulder, or dehiscence (p = 0.69) did not differ. Conclusion: Both techniques provide comparable clinical and structural outcomes, although inference is limited by the predominance of non-randomized evidence. Arthroscopy may be associated with modest pain advantages; however, analgesia regimens were not consistently reported. Overall functional outcomes appear comparable between techniques. Technique selection should reflect the surgeon expertise and patient priorities.