How to Manage the Spinoglenoid Notch Cyst: A Systematic Review and Meta-analysis.

Background: Spinoglenoid notch cysts can cause suprascapular nerve compression, posterior shoulder pain, and infraspinatus weakness. Although multiple open and arthroscopic operative approaches have been described, the optimal management strategy remains unclear. Purpose: To (1) analyze existing evidence on the management of spinoglenoid notch cysts, (2) compare outcomes among different operative approaches, and (3) provide a practical management algorithm based on cyst characteristics. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the PubMed, Scopus, and Embase databases from inception to August 2025. Eligible studies included clinical reports on the operative or nonoperative management of spinoglenoid notch cysts, with postoperative outcomes. Data on patient characteristics, procedures, patient-reported outcome measures, recurrence, reoperation, and complication rates were extracted. Random- and common-effects models were used for pooled analyses. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies criteria. Results: A total of 32 studies comprising 562 shoulders met the inclusion criteria. Overall risk of bias was moderate. Arthroscopic decompression with labral repair was the most common intervention (n = 271 [48%]). Across all studies, significant improvements were observed in the American Shoulder and Elbow Surgeons, Constant-Murley, and visual analog scale pain scores. Meta-analysis revealed the lowest cyst recurrence rate for arthroscopic decompression with labral repair (3% [95% CI, 0.02-0.06]), compared with arthroscopic decompression alone (12%), arthroscopic labral repair alone (6%), and open decompression (12%). Reoperation rates were lowest with open decompression (0%) and arthroscopic labral repair (3%-4%), and highest with arthroscopic decompression without labral repair (9%). Complication rates were uniformly low across all techniques (<5%). Conclusion: Arthroscopic decompression with concurrent labral repair demonstrated favorable outcomes and low recurrence rates in properly selected patients with spinoglenoid notch cysts. Both arthroscopic and open approaches yield excellent pain relief and functional recovery. Arthroscopic decompression with labral repair offers a safe, effective, and minimally invasive option for nonloculated cysts. For very large and/or loculated cysts, open decompression with removal of the cyst structure itself should be considered.