Outcomes of Rotator Cuff Repair: Open vs. Arthroscopic Approaches in Patients with Diabetes or Hyperlipidemia

Abstract

Rotator cuff injuries are a common cause of shoulder dysfunction, with diabetes mellitus and hyperlipidemia contributing to increased tendon vulnerability and impaired healing. In this article, a critical evaluation is presented on the comparative outcomes of open versus arthroscopic rotator cuff repair (RCR) in patients with these metabolic conditions. Findings suggest that arthroscopic RCR compared to open RCR offers advantages such as reduced tissue disruption, shorter recovery times, and lower infection rates, making it a preferred choice for metabolically compromised patients. However, open RCR provides superior visualization and structural support, as well as better function, benefiting patients with extensive tendon damage. In diabetics there was higher retear and infection rates than non-diabetics, particularly with open RCR, while those with hyperlipidemia exhibited impaired tendon healing and increased postoperative complications, with mixed effects from statin therapy. Despite these findings, existing research lacks large-scale, controlled studies directly comparing surgical outcomes in these high-risk populations. Given the chronic inflammatory and metabolic impairments associated with diabetes mellitus and hyperlipidemia, surgical decisions should be tailored to patient-specific factors, including lipid and glycemic control, tendon integrity, and tear severity. Arthroscopy appears to be the preferable option due to minimizing surgical trauma, lower retear rates and faster return-to-work times; meanwhile, open repair remains valuable in cases requiring extensive intervention.

Keywords: Arthroscopy; Diabetes mellitus; Hyperglycemia; Hyperlipidemia; Post-operative complications; Rotator cuff injury; Rotator cuff repair.

Figure 1:

Summary of Open vs. Arthroscopic approaches comparing incision size, infection rate, hospital stay and cost. The illustration depicts the two surgical approaches as well as the common surgical tools used.

Figure 2:

Impact of diabetes mellitus and hyperlipidemia on tissue healing. Figure depicts pathophysiology of tendon structure due to comorbidities and impact on postoperative complications.

Figure 3:

Summarized decision-making tree for surgical approach taking into account tear size, if a comorbidity is present and finally important factors to control such as statins and glycemic control.