Rotator Cuff Repair: Arthroscopic vs. Mini-Open Surgery – Pros and Cons

Introduction

The rotator cuff is a group of tendons in your shoulder that help you lift and rotate your arm. When one or more of these tendons tear, it can cause pain, weakness, and trouble reaching overhead. If the tear does not heal with rest, therapy, or shots, surgery may be needed.

There are two main types: arthroscopic (small cuts, camera-guided) and mini-open (larger cut, direct view). Both can help, but there are differences.

What Is Arthroscopic Rotator Cuff Repair?

• Done through small cuts in the skin.

• A tiny camera (arthroscope) is used to see inside the shoulder.

• Special tools are used to stitch the tendon back to the bone.

• All work is done without opening the whole shoulder joint.

What Is Mini-Open Rotator Cuff Repair?

• Often combines both arthroscopic and open techniques.

• The surgeon may use a scope to clean and inspect the joint.

• Then, a smaller incision (about 2–3 inches) is made to repair the tendon directly.

• This approach gives the surgeon a clear view of the tendon with less muscle disruption than a traditional open surgery.

When Is Each Used?

• Arthroscopic repair is most common today. It works well for most kinds of tears.

Mini-open repair may be chosen for:

• Large or complex tears.

• When the tendon is hard to reach arthroscopically

• Situations where direct visualization helps the surgeon make a secure repair.

Pros and Cons of Arthroscopic Repair

Pros

• Smaller scars.

• Less injury to nearby muscles.

• Possibly less pain in the first weeks after surgery.

Cons

• Surgery takes longer.

• Requires special training and tools.

Pros and Cons of Mini-Open Repair

Pros

• Direct view of the tendon and bone.

• Long track record of success.

Cons

• Larger scar.

• Possibly more pain in the first weeks after surgery.

Recovery: What to Expect

• Both surgeries usually need a sling for 4–6 weeks.

• Physical therapy is key to regain motion and strength.

• Most people return to daily activities in 3–4 months.

• Full recovery may take 6–12 months, no matter which method is used.

Frequently Asked Questions

Which surgery is better?

Both work very well. The choice depends on the size and character of the tear and your surgeon’s recommendation.

Will my shoulder be normal again?

Most patients get much less pain and better motion, but the shoulder may not be “perfect,” especially after very large tears.

Does one surgery last longer?

Long-term results are similar. What matters most is the quality of the repair and following therapy.

Conclusion

Both arthroscopic and mini-open rotator cuff repair can reduce pain and improve shoulder function. Your surgeon will choose the best method based on your tear and your needs.

Call to book an appointment to determine which type of rotator cuff repair is right for you:

646-665-6784

---

About the Author

C. Lucas Myerson, MD – Orthopedic surgeon specializing in shoulder and elbow surgery.

Disclaimer

This article is for educational purposes only. It is not a substitute for medical advice. Always talk to your doctor about your specific condition.

Sources

• American Academy of Orthopaedic Surgeons (AAOS). OrthoInfo: Rotator Cuff Tears: Surgical Treatment Options

• Migliorini F et al. Arthroscopic versus mini-open rotator cuff repair: A meta-analysis. Surgeon. 2023.

• Plachel F et al. A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs. Am J Sports Med. 2023.

• Sakha S et al. Update on all-arthroscopic vs. mini-open rotator cuff repair: A systematic review and meta-analysis. J Orthop. 2021.