Prior to 1972, a variety of operations were performed to treat rotator cuff pain. Neer in 1972 recommended an anterior acromioplasty, which quickly became the standard of care based on Level IV and Level V evidence. In 1987, Ellman offered an arthroscopic approach to performing the acromioplasty; since then Level I studies have been conducted to assess the success of the arthroscopic approach. The purpose of our systematic review was to whether an arthroscopic approach to acromioplasty produces different outcomes (primary outcome pain relief) when compared to traditional open techniques. We performed a systematic literature review. We identified four Level I and one Level II randomized controlled prospective studies of four patient cohorts. While these studies had substantial flaws which could introduce bias, we found no differences between arthroscopic and open approaches for pain. Other outcomes that showed no difference in technique included UCLA shoulder scores, range of motion and strength. The data for the time required to perform surgery and the time to return to work for patients could not be used to recommend one approach over the other. Therefore, with the data available from four Level I and one Level II randomized controlled trials, we could not find appreciable differences between arthroscopic and open acromioplasty.