OPEN VS ARTHROSCOPIC REPAIRS

There were two high quality studies (Carr, 2017; Mohtadi, 2008) comparing the outcome of arthroscopic and either open or mini-open repair and seven moderate quality studies (Carbonel, 2012; Hasler, 2020; Jithesh, 2024; Liu, 2017; MacDermid, 2021; Ribeiro, 2023; van der Zwaal, 2013) comparing perioperative pain and morbidity between arthroscopic and open rotator cuff repair.

None of these seven studies reported any significant difference in the outcome of any of the three techniques. Multiple other comparative studies of lower quality exist regarding this topic, some with differing outcomes, but only the best available evidence was considered in the development of this recommendation.

In a prospective, randomized high quality study, Carr et al. (2017) evaluated the outcome of 273 patients randomized to either open/mini-open, or all-arthroscopic repair. There was no difference in outcome scores, with a 40% healing rate in both groups. This study extended the preliminary results of Carr et al. study reported in 2014.

Mohtadi et al. 2008 published a high-quality study comparing open to mini-open repair showed no difference in PROs between techniques at average follow-up of 28 months. No post-operative imaging was performed.
In a moderate quality prospective randomized study of 100 patients, Liu et al. 2017 showed no difference in outcome between all-arthroscopic and mini-open repairs for either patient-reported outcomes, retear rates, or occurrence of adhesive capsulitis at one year.
Van der Zwaal et al. 2013 presented a moderate-quality study comparing all-arthroscopic to mini-open repair at one year. Final PROs, retear rates, and presence of associated adhesive capsulitis were similar between both groups.

In evaluating the literature which forms the basis for this recommendation, two moderate-quality studies (Liu et al. 2017 and Van der Zwaal et al. 2013) showed faster short-term recovery with all-arthroscopic repair. Liu et al. 2017 showed significant differences in both range of motion and VAS scores, as well as superior scores on both the DASH and Constant PRJOs up to one-month postoperatively. Liu concluded that the all-arthroscopic procedure has better recovery at short-term follow-ups. Similarly, Van der Zwaal et al. noted improved range of motion, VAS, and DASH scores at six weeks comparing all-arthroscopic to mini-open repair. They felt that “Patients do attain the benefits of treatment somewhat sooner (6 weeks) with the arthroscopic procedure.”

Risks and Harms of Implementing this Recommendation
There are no risks associated with implementing this recommendation.

Future Research
Given the conflicting information available regarding improvements in post-operative pain and early recovery with all-arthroscopic repair, further studies are needed in this area to establish benefits of this procedure.