Effects of arthroscopic vs. mini-open rotator cuff repair on function, pain & range of motion. A systematic review and meta-analysis

Autoři: Goris Nazari aff001;  Joy C. MacDermid aff001;  Dianne Bryant aff001;  Neha Dewan aff004;  George S. Athwal aff002
Působiště autorů: School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada aff001;  Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON Canada aff002;  Roth McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada aff003;  Department of Health Sciences, Lakehead University, Canada aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222953



To assess the effectiveness of arthroscopic versus mini-open rotator cuff repair on function, pain and range of motion at 3-, 6- and 12-month follow ups.


Systematic review and meta-analysis of randomized controlled trials.


Clinical setting.


Patients 18 years and older with a rotator cuff tear.


Arthroscopic/mini-open rotator cuff repair surgery followed by post operative rehabilitation.

Main outcome measures

Function and pain.


Six RCTs (n = 670) were included. The pooled results, demonstrated no significant difference between arthroscopic and mini open approach to rotator cuff repair on function (very low quality, 4 RCTs, 495 patients, SMD 0.00, 3-month; very low quality, 4 RCTs, 495 patients, SMD -0.01, 6-month; very low quality, 3 RCTs, 462 patients, SMD -0.09, 12-months). For pain, the pooled results, were not statistically different between groups (very low quality, 3 RCTs, 254 patients, MD -0.21, 3-month; very low quality, 3 RCTs, 254 patients, MD -0.03, 6-month; very low quality, 2 RCTs, 194 patients, MD -0.35, 12-months).


The effects of arthroscopic compared to mini-open rotator cuff repair, on function, pain and range of motion are too small to be clinically important at 3-, 6- and 12-month follow ups.

Klíčová slova:

Arthroscopy – Publication ethics – Randomized controlled trials – Strength training – Surgical and invasive medical procedures – Surgical repair – Systematic reviews


1. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010; 19(1):116–20. doi: 10.1016/j.jse.2009.04.006 19540777

2. Huang R, Wang S, Wang Y, Qin X, and Suna Y. Systematic Review of All- Arthroscopic Versus Mini-Open Repair of Rotator Cuff Tears: A Meta-Analysis. Sci Rep. 2016; 6: 22857. doi: 10.1038/srep22857 26947557

3. Ji X, Bi C, Wang F and Wang Q. Arthroscopic Versus Mini-Open Rotator Cuff Repair: An Up-to-Date Meta-analysis of Randomized Controlled Trials. Arthroscopy, 2015; 31(1):118–124. doi: 10.1016/j.arthro.2014.08.017 25442664

4. Shan L, Fu D, Chen K, Cai Z and Li G. All-Arthroscopic versus Mini-Open Repair of Small to Large Sized Rotator Cuff Tears: A Meta-Analysis of Clinical Outcomes. PloS One, 2014 (9):4; e94421. doi: 10.1371/journal.pone.0094421

5. Chahal J, Van Thiel GS, Mall N, Heard W, Bach BR, Cole BJ, et al. The role of plateletrich plasma in arthroscopic rotator cuff repair: A systematic review with quantitative synthesis. Arthroscopy 2012; 28: 1718–1727. doi: 10.1016/j.arthro.2012.03.007 22694941

6. Peters KS, McCallum S, Briggs L and Murrell GA. A comparison of outcomes after arthroscopic repair of partial versus small or medium-sized full-thickness rotator cuff tears. J Bone Joint Surg Am 2012;94:1078–1085. doi: 10.2106/JBJS.J.00519 22717826

7. Ames JB, Horan MP, Van der Meijden OA, et al. Association between acromial index and outcomes following arthroscopic repair of full-thickness rotator cuff tears. J Bone Joint Surg Am 2012;94:1862–1869. doi: 10.2106/JBJS.K.01500 23079878

8. Denard PJ, Ladermann A, Jiwani AZ and Burkhart SS. Functional outcome after arthroscopic repair of massive rotator cuff tears in individuals with pseudo-paralysis. Arthroscopy 2012;28:1214–1219. doi: 10.1016/j.arthro.2012.02.026 22608887

9. Verma NN, Dunn W, Adler RS, Cordasco FA, Allen A, MacGillivray J, et al. All-arthroscopic versus mini-open rotator cuff repair: A retrospective review with minimum 2-year follow-up. Arthroscopy 2006;22:587–594. doi: 10.1016/j.arthro.2006.01.019 16762695

10. Kang L, Henn RF, Tashjian RZ and Green A et al. Early outcome of arthroscopic rotator cuff repair: A matched comparison with mini-open rotator cuff repair. Arthroscopy 2007;23: 573–582:582.e1-582.e2. doi: 10.1016/j.arthro.2007.01.011 17560471

11. Pearsall AWIV, Ibrahim KA and Madanagopal SG. The results of arthroscopic versus mini-open repair for rotator cuff tears at mid-term follow-up. J Orthop Surg Res 2007;2:24. doi: 10.1186/1749-799X-2-24 18053153

12. Nazari G, MacDermid JC, Bryant D and Athwal GS. The effectiveness of surgical vs conservative interventions on pain and function in patients with shoulder impingement syndrome. A systematic review and meta-analysis. Plos One, 2019, https://doi.org/10.1371/journal.pone.0216961

13. Balshem H, Helfand M, Schu ¨nemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011; 64: 401–6. doi: 10.1016/j.jclinepi.2010.07.015 21208779

14. Higgins JPT, Altman DG, Gøtzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Br Med J. 2011; 343: 889–93.

15. Liberati A, Altman DG, Tetzlaff J, Cynthia Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700. doi: 10.1136/bmj.b2700 19622552

16. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011; 64(4):383–94. doi: 10.1016/j.jclinepi.2010.04.026 21195583

17. Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, et al. GRADE guidelines: 4. Rating the quality of evidence—Study limitations (risk of bias). J Clin Epidemiol. 2011; 64 p. 407–15. doi: 10.1016/j.jclinepi.2010.07.017 21247734

18. Guyatt GH, Oxman AD, Montori V, Vist G, Kunz R, Brozek J, et al. GRADE guidelines: 5. Rating the quality of evidence—Publication bias. J Clin Epidemiol. 2011; 64(12):1277–82. doi: 10.1016/j.jclinepi.2011.01.011 21802904

19. Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence—Imprecision. J Clin Epidemiol. 2011; 64(12):1283–93. doi: 10.1016/j.jclinepi.2011.01.012 21839614

20. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 8. Rating the quality of evidence—Indirectness. J Clin Epidemiol. 2011; 64(12):1303–10. doi: 10.1016/j.jclinepi.2011.04.014 21802903

21. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 7. Rating the quality of evidence—Inconsistency. J Clin Epidemiol. 2011; 64: 1294–1302. doi: 10.1016/j.jclinepi.2011.03.017 21803546

22. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg. 2009; 18:927–932. doi: 10.1016/j.jse.2009.03.021 19535272

23. Norman GR, Sloan JA, Wyrwich KW. The truly remarkable universality of half a standard deviation: Confirmation through another look. Vol. 4, Expert Review of Pharmacoeconomics and Outcomes Research. 2004; 581–585. doi: 10.1586/14737167.4.5.581 19807551

24. Simovitch R, Flurin PH, Wright T, Zuckerman JD and Roche CP. Quantifying success after total shoulder arthroplasty: the minimal clinically important difference. J Shoulder Elbow Surg (2018) 27, 298–305. doi: 10.1016/j.jse.2017.09.013 29162305

25. Higgins JPT, and Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook. cochrane.org.

26. Cho C-H, Song K-S, Jung G-H, Lee YK and Shin HK. Early Postoperative Outcomes Between Arthroscopic and Mini-open Repair for Rotator Cuff Tears. Orthopedics. 2012;35(9): e1347–52. doi: 10.3928/01477447-20120822-20 22955400

27. Kasten P, Keil C, Grieser T, Raiss P, Streich N and Loew. Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon. Int Orthop. 2011;35(11):1663–70. doi: 10.1007/s00264-011-1262-2 21533643

28. Liu J, Fan L, Zhu Y, Yu H, Xu T and Li G. Comparison of clinical outcomes in all-arthroscopic versus mini-open repair of rotator cuff tears. Med (Baltimore). 2017; 96(11). doi: 10.1097/MD.0000000000006322 28296750

29. MacDermid JC, Holtby R, Razmjou H, Bryant D and JOINTS Canada. Arthroscopic versus mini-open rotator cuff repair: A Randomized Trial and Meta-analysis. Protocol number [NCT00128076]. BMC Musculoskeletal Disorders 20067:25. doi: 10.1186/1471-2474-7-25

30. Van Der Zwaal P, Thomassen BJW, Nieuwenhuijse MJ, Lindenburg R, Swen JW and Van Arkel ER. Clinical outcome in all-arthroscopic versus mini-open rotator cuff repair in small to medium-sized tears: A randomized controlled trial in 100 patients with 1-year follow-up. Arthroscopy, 2013;29(2):266–73. doi: 10.1016/j.arthro.2012.08.022 23206691

31. Zhang Z, Gu B, Zhu W, Zhu L and Li Q. Arthroscopic versus mini-open rotator cuff repair: A prospective, randomized study with 24-month follow-up. Eur J Orthop Surg Traumatol. 2014;24(6):845–50. doi: 10.1007/s00590-013-1263-5 23812851

32. Hui YJ, Teo AQA, Sharma S, Tan BHM, and Prem Kumar V. Immediate costs of mini-open versus arthroscopic rotator cuff repair in an Asian population. Journal of Orthopaedic Surgery, 2017. https://doi.org/10.1177/2309499016684496

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2019 Číslo 10
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