MASSIVE UNREPAIRABLE TEARS WITH ARTHROPATHY (REVERSE ARTHROPLASTY)

The recommendation was downgraded for heterogeneity, generalizability, and applicability. Ameziane et al (2024, moderate quality) demonstrated better CM scores and internal rotation when performing RSA and SSC repair (versus non-repair) in patients with MIRCTs. Baek et al (2022, low quality) compared outcomes between patients who underwent RSA with LDTM transfer versus RSA alone for cuff-tear arthropathy. The LDTM transfer group had significantly better average CM scores, activities of daily living, internal rotation, toileting, belly-press test, bear-hug test, lift-off test, and strength.  The remaining studies (i.e. comparing HA versus RSA, medialized versus lateralized RSA, HA, etc.) are of low quality. Based upon these findings (heterogeneity, generalizability, applicability), the strength of recommendation has been downgraded to consensus.

Risks and Harms of Implementing this Recommendation

Reverse shoulder arthroplasty is an option in patients with MIRCTs and glenohumeral arthropathy. Those patients who undergo RSA may not experience complete resolution of his/her shoulder symptoms and may not achieve clinically significant improvement. Additionally, this specific surgical option has distinct risks, complications, and potential outcomes which may not be acceptable to the patient, thus requiring additional surgical intervention/revision.

Future Research

Future studies are necessary to confirm RSA as a long-term solution in patients with rotator cuff arthropathy when compared to non-surgical and other surgical options.