Comparative Outcomes of Arthroscopic Versus Open Rotator Cuff Repair

Abstract

Rotator cuff repair has shifted almost entirely from the classical open, deltoid-splitting approach toward all-arthroscopic and arthroscopically assisted mini-open techniques, but whether this shift preserves functional outcomes and simply trades one set of risks for another has taken over a decade of comparative trial evidence to clarify. This short communication synthesizes that evidence, centered on the JOINTS Canada multicenter randomized trial (n=274) comparing all-arthroscopic against mini-open repair, its accompanying meta-analysis, earlier randomized trials, and independent systematic reviews. Across this evidence base, arthroscopic and mini-open repair produce statistically and largely clinically equivalent patient-reported outcomes at one to two years, with disease-specific quality-of-life scores improving similarly in both groups and only small, measurement-noise-level differences between them. Technique-specific risk, rather than functional outcome, is where the approaches diverge most clearly: fully open exposure carries a recognized risk of deltoid detachment that arthroscopic and mini-open techniques were designed to avoid, while structural retear across all exposures appears driven mainly by tear size, tissue quality, and fixation construct rather than incision size. Because almost none of the modern randomized evidence directly compares arthroscopic repair against a truly open, deltoid-takedown technique, and massive or irreparable tears remain underrepresented in the trial base, the strongest remaining gap is a comparative cohort that pairs standardized retear imaging with explicit deltoid-function outcomes across all three exposures.