BACKGROUND: The purpose of the present study was to retrospectively compare the clinical and radiologic outcomes of arthroscopic suture anchor fixation and open screw fixation for acute large anterior glenoid rim fractures. METHODS: This study enrolled patients with acute large anterior glenoid rim fractures treated with arthroscopic suture anchor fixation (group A) or open screw fixation (group O) from January 2013 to June 2020 with a minimum follow-up of＞2 years. The Subjective Shoulder Value, American Shoulder and Elbow Surgeons score, Rowe score, Constant score, range of motion, recurrent instability rate, and complications were recorded as clinical results. The quality of the postoperative reduction, reconstructed glenoid sizes, rate of fracture healing, and progression of osteoarthritis (OA) were evaluated as radiologic outcomes. RESULTS: This retrospective study included 66 patients, including 37 in Group A and 29 in Group O with a mean follow-up of 46.9 (range: 24.3-94.2) months and a mean patient age of 46.8 (range: 21-69) years. No significant differences were found in the clinical outcomes between the two groups. A significant range of motion limitation in all planes was found in both groups and group O showed more limitations in external rotation at the side (18° vs. 10°, P = .002). The reduction quality was better in group O (P <
.001). However, there was no significant difference between the two groups in terms of reconstructed glenoid size (101.6% ± 4.6% vs. 100.6% ± 7.1%, P = .460) and the rate of OA progression (26.9% vs. 20%, P = .525). CONCLUSION: Arthroscopic suture anchor fixation and open screw fixation achieved similar clinical outcomes, reconstructed glenoid sizes, and OA progression in patients with acute large anterior glenoid rim fractures. Arthroscopic suture fixation showed a poorer quality of reduction but less external rotation at the side limitations.