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.