Outcomes of reverse shoulder arthroplasty following failed superior capsular reconstruction versus rotator cuff repair

Abstract

Rotator cuff tears (RCTs) are a common injury, with a prevalence of approximately 40% in adults aged over 60 years. The superior capsular reconstruction (SCR) has emerged as a potential surgical option for younger patients with massive irreparable tears and limited glenohumeral arthritis. Nonetheless, for patients with rotator cuff arthropathy and advanced degenerative changes of the glenohumeral joint (Hamada class 3 or greater), reverse shoulder arthroplasty (RSA) remains the gold standard. Outcomes in RSA after failed SCR are inferior to outcomes after failed RCR, and outcomes after both failed RCR and SCR are inferior to those following primary RSA. However, there is no evidence of increased complication rates or decreased survivorship. Much of the current literature is limited to small case series and retrospective reviews, which introduce selection biases and potential intrinsic differences between RCR and SCR cohorts that confound analyses. Ultimately, the discrepancy in outcomes of RSA following SCR versus RCR is likely multifactorial and not entirely explained by existing data. With the advent of new graft options and refined surgical techniques, it is possible that such differences may not be as greatly appreciated moving forward.