Systematic review of arthroscopic rotator cuff repair and mini-open rotator cuff repair.

Introduction otator cuff repair is one of the most common surgical procedures performed in the shoulder, and the benefit of repair is well known. Over the past decade, the treatment of rotator cuff tears has evolved from an open procedure to an arthroscopic-assisted (mini-open) technique to an all-arthroscopic technique. Traditional open rotator cuff repairs produce satisfactory results when used for the treatment of nonmassive tears (<5 cm). However, this procedure has been associated with morbidity such as severe early postoperative pain, deltoid detachment and/or weakness, and arthrofibrosis. Mini-open repairs were developed because they had the potential advantage of less deltoid morbidity, and they have demonstrated results that have been similar to those of open repairs (Figs. 1-A through 1-D). With recent advances in arthroscopic techniques, many surgeons are now performing complete arthroscopic repairs. The potential advantages of this procedure include less pain, more rapid rehabilitation, the ability to treat intra-articular lesions, smaller skin incisions, less soft-tissue dissection, and an extremely low risk of deltoid detachment (Figs. 2-A through 2-E). In the short and long term, the arthroscopic approach has shown promising results. Despite these advantages, the use of the complete arthroscopic repair is technically demanding and requires a large-volume practice in order for a surgeon to obtain proficiency in this procedure. Because of the technical demands of this procedure, many orthopaedic surgeons still consider the mini-open repair to be the gold standard for rotator cuff repair. We hypothesized that arthroscopic rotator cuff repair produces clinical results comparable with those of mini-open rotator cuff repair, with fewer complications. In order to compare the mini-open and all-arthroscopic techniques, we performed a qualitative systematic review with use of a defined methodology to collect the most relevant information to answer a specific clinical question. This analysis included published literature on mini-open and all-arthroscopic techniques in patients with full-thickness rotator cuff tears with a mean duration of twenty-four months of followup. The purpose of the present study was to compare the clinical outcomes of mini-open and all-arthroscopic techniques of rotator cuff repair with use of a systematic review of the published literature.