PurposeThis investigation aimed to compare the medical efficacy of the knotted and knotless suture-bridge procedures in rotator cuff repair.MethodsThe Pubmed, Embase, and Cochrane Library datasets were searched for all available publications comparing the medical results of arthroscopic rotator cuff repairs utilizing knotted or knotless suture-bridge procedures. Two researchers utilized Newcastle-Ottawa Scale and Cochrane risk-of-bias tool to evaluate the included studies. Employing Revman 5.3 software, meta-analysis was conducted following the PRISMA reporting guideline.ResultsEleven investigations with 1083 patients were considered suitable for the final meta-analysis. 522 individuals were assigned to the knotted group, whereas 561 were assigned to the knotless group. No statistical difference was found between the knotted and knotless groups, regarding VAS score (WMD, 0.17; 95% CI, − 0.10 to 0.44; P = 0.21); Constant score (WMD, -1.50; 95% CI, − 3.52 to 0.52; P = 0.14); American Shoulder and Elbow Surgeons Shoulder (WMD, -2.02; 95% CI, − 4.53 to 0.49; P = 0.11); University of California Los Angeles score (WMD, -0.13; 95% CI, − 0.89 to 0.63; P = 0.73); ROM of flexion (WMD, 1.57; 95% CI, − 2.11 to 5.60; P = 0.37), abduction (WMD, 1.08; 95% CI, − 4.53 to 6.70; P = 0.71) and external rotation (WMD, 1.90; 95% CI, − 1.36 to 5.16; P = 0.25); re-tear rate (OR, 0.74; 95% CI, 0.50 to 1.08; P = 0.12), and medical complications (OR, 0.90; 95% CI, 0.37 to 2.20; P = 0.82).ConclusionFor arthroscopic rotator cuff repairs, there were no statistical differences in medical results among knotted and knotless suture-bridge procedures. Overall, both techniques showed excellent clinical outcomes and could be safely utilized to treat rotator cuff injuries.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12893-023-02060-0.