Treatment outcomes for rotator cuff arthropathy: A systematic review of reverse total shoulder arthroplasty with or without augmentation.

Abstract

Rotator cuff arthropathy (RCA) involves shoulder joint degeneration due to rotator cuff insufficiency, leading to pain, limited motion, and functional decline. Reverse total shoulder arthroplasty (RTSA) with rotator cuff repair, with tendon transfer, and without tendon repair or transfer are all commonly used to restore function if conservative treatments fail. This study systematically compares outcomes between the three methods. A literature review was conducted using PubMed, Embase, MEDLINE, and Cochrane. Inclusion criteria: patients 18 years or older who were treated with RTSA, articles published between January 2000 and January 2025, and articles including functional outcome scores. Exclusion criteria were articles not written in English, case reports, cadaveric or animal studies, and articles focusing on mechanisms other than RCA (i.e., fractures). A total of 15 studies including 1404 patients were analyzed. There were 513 males and 829 females, with a mean age of 71.0 years. Across all groups, pain and function improved following RTSA. The no-repair cohort achieved a Constant score of 61.9 and forward elevation of 144.8°, while the subscapularis repair cohort showed a Constant score of 65 and elevation of 141.8°. Latissimus/teres minor transfer produced similar forward elevation (145.7°) but lower external rotation (33.8°). The pectoralis major transfer group demonstrated the greatest motion (forward elevation 155°, external rotation 41°). Complications were infrequent overall. Scapular notching (55.45 %) predominated in the no-repair group, whereas dislocation (7.7 %), revision (8.1 %), and humeral osteolysis (80 %) occurred more often with repair. Infection was rare (<1 %) across cohorts. Reverse total shoulder arthroplasty is a standard practice for treating rotator cuff arthropathy. The addition of subscapularis repair or tendon transfer did not yield significant gains in motion or outcomes, suggesting that cuff or tendon augmentation offers no clear advantage over standard RTSA in achieving patient satisfaction or function.