Arthroscopic repair versus open repair for subscapularis tears with or without concomitant supraspinatus tears: a systematic review and meta-analysis of comparative studies.

The optimal surgical approach for repairing subscapularis (SSC) tendon tears remains debated. This systematic review and meta-analysis compares outcomes of arthroscopic versus open repair for SSC tears, with and without concomitant supraspinatus (SSP) tears. We systematically searched PubMed, Embase, Scopus, and Web of Science for comparative studies on adults with full-thickness SSC tears. Primary outcomes included functional scores (CMS/ASES), range of motion (ROM), and postoperative SSC integrity (retear, belly press, lift-off tests). Analyses were performed using meta R package. Eight studies comprising 328 patients (166 arthroscopic, 162 open) were included. Overall, no statistically significant difference was found in postoperative functional scores between the two approaches (SMD: 0.20, 95% CI [- 0.36-0.77]). In the subgroup analysis of iSSC tears, the outcomes were comparable across all the measured variables. However, in the subgroup of studies including patients with both iSSC and combined anterosuperior (SSC ± SSP) tears, arthroscopic repair significantly improved forward elevation (MD: 11.29°, 95% CI [5.16-17.42]) and significantly decreased the odds of a positive or intermediate belly press sign (OR: 0.35, 95% CI [0.14-0.85]) and lift-off sign (OR: 0.35, 95% CI [0.15-0.79]). No significant difference in retear rates was observed between the groups (OR: 0.97, 95% CI [0.29-3.21]). The choice of surgical approach should be individualised based on tear complexity and surgeon experience. For iSSC tears, open and arthroscopic repairs offer comparable outcomes. For combined anterosuperior tears, arthroscopic repair might offer better functional recovery. Registration: PROSPERO CRD420251078954.