MASSIVE, UNREPAIRABLE ROTATOR CUFF TEAR WITHOUT ARTHROPATHY (REVERSE ARTHROPLASTY)

The recommendation was downgraded for heterogeneity, generalizability, and applicability. The studies were of low quality and did not demonstrate superiority of one treatment option over another (HA versus RSA). Specific studies such as 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.