Reverse shoulder arthroplasty (RSA) is an established operative treatment for failed rotator cuff repair (RCR) that may not be amenable to revision repair. The purpose of this meta-analysis is to evaluate the clinical outcomes for patients undergoing RSA following prior failed RCR compared with patients without prior RCR undergoing primary RSA.
Methods
A systematic search of articles in Pubmed, EMBASE and The Cochrane Library databases was carried out according to PRISMA guidelines. Comparative studies assessing outcomes of RSA after failed RCR versus primary RSA were included.
Results
Seven studies with 2149 total patients were included; 760 patients had a prior RCR and 1389 patients did not have a prior RCR. Prior failed RCR resulted in significantly lower postoperative ASES scores (mean difference [MD], −8.31 95% confidence interval [CI] −10.96, −5.66), less forward flexion (MD, −6.71 95%CI −11.75, −1.67), and higher VAS pain scores (MD; 0.85, 95% CI 0.47, 1.22) when compared to primary RSA. There were no significant differences in external rotation, complications rate, or rate of revision.
Conclusion
This study found that failed RCR prior to RSA was associated with lower functional outcomes scores, higher pain scores, and worse range of motion compared to primary RSA without prior RCR.
FrenchCLeeKJacobsonJ, et al.Imaging of tendinopathies in advancing age. Radiol Clin North Am2022; 60: 583–592.
2.
SchmidtCCMorreyBF. Management of full-thickness rotator cuff tears: appropriate use criteria. J Shoulder Elbow Surg2015; 24: 1860–1867.
3.
GalatzLMBallCMTeefeySA, et al.The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am2004; 86: 219–224.
4.
NeriBRChanKWKwonYW. Management of massive and irreparable rotator cuff tears. J Shoulder Elbow Surg2009; 18: 808–818.
5.
GarciaGHLiuJNWongA, et al.Hyperlipidemia increases the risk of retear after arthroscopic rotator cuff repair. J Shoulder Elbow Surg2017; 26: 2086–2090.
6.
KimHMCaldwellJ-MEBuzaJA, et al.Factors affecting satisfaction and shoulder function in patients with a recurrent rotator cuff tear. J Bone Joint Surg Am2014; 96: 106–112.
7.
DieboldGLamPWaltonJ, et al.Relationship between age and rotator cuff retear: a study of 1,600 consecutive rotator cuff repairs. J Bone Joint Surg Am2017; 99: 1198–1205.
NamdariSDoneganRPChamberlainAM, et al.Factors affecting outcome after structural failure of repaired rotator cuff tears. J Bone Joint Surg Am2014; 96: 99–105.
10.
NolanBMAnkersonEWiaterJM. Reverse total shoulder arthroplasty improves function in cuff tear arthropathy. Clin Orthop Relat Res2011; 469: 2476–2482.
11.
LeeSKimD-HKimSG, et al.Does reverse shoulder arthroplasty improve emotional status and quality of life in patients with rotator cuff insufficiency? Prospective sequential follow-up study. J Shoulder Elbow Surg2023; 32: 1–8.
12.
MechlenburgIRasmussenSUnbehaunD, et al.Patients undergoing shoulder arthroplasty for failed nonoperative treatment of proximal humerus fracture have low implant survival and low patient-reported outcomes: 837 cases from the Danish shoulder arthroplasty registry. Acta Orthop2020; 91: 319–325.
13.
EricksonBJBohlDDColeBJ, et al.Reverse total shoulder arthroplasty: Indications and techniques across the world. Am J Orthop (Belle Mead NJ)2018; 47: 1–17.
14.
ErnstbrunnerLSuterACatanzaroS, et al.Reverse total shoulder arthroplasty for massive, irreparable rotator cuff tears before the age of 60 years: long-term results. J Bone Joint Surg Am2017; 99: 1721–1729.
15.
VillacisDSivasundaramLPannellWC, et al.Complication rate and implant survival for reverse shoulder arthroplasty versus total shoulder arthroplasty: results during the initial 2 years. J Shoulder Elbow Surg2016; 25: 927–935.
16.
ForlizziJMPuzzitielloRNHartP-A, et al.Predictors of poor and excellent outcomes after reverse total shoulder arthroplasty. J Shoulder Elbow Surg2022; 31: 294–301.
17.
MatsenFARussSMVuPT, et al.What factors are predictive of patient-reported outcomes? A prospective study of 337 shoulder arthroplasties. Clin Orthop Relat Res2016; 474: 2496–2510.
18.
DeanRSWatermanBRNaylorAJ, et al.Failed prior rotator cuff repair is associated with worse clinical outcomes after reverse total shoulder arthroplasty. Semin Arthroplasty2022; 32: 272–278.
19.
SadoghiPVavkenPLeithnerA, et al.Impact of previous rotator cuff repair on the outcome of reverse shoulder arthroplasty. J Shoulder Elbow Surg2011; 20: 1138–1146.
20.
WernerCMLSteinmannPAGilbartM, et al.Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am2005; 87: 1476–1486.
21.
MarigiEMTamsCKingJJ, et al.Reverse shoulder arthroplasty after prior rotator cuff repair: a matched cohort analysis. J Am Acad Orthop Surg2022; 30: e395–e404.
22.
ShieldsEJWKoueiterDMMaerzT, et al.Previous rotator cuff repair is associated with inferior clinical outcomes after reverse total shoulder arthroplasty. Orthop J Sports Med2017; 5: 232596711773031.
23.
PatelMKStoneWZSchochBS, et al.Does having prior rotator cuff repair affect outcomes in reverse shoulder arthroplasty? A matched cohort study. Orthop Traumatol Surg Res2020; 106: 661–665.
24.
EricksonBJLingDWongA, et al.Does having a rotator cuff repair prior to reverse total shoulder arthroplasty influence the outcome?Bone Joint J2019; 101-B: 63–67.
25.
ChoNSChaSWRheeYG. Alterations of the deltoid muscle after open versus arthroscopic rotator cuff repair. Am J Sports Med2015; 43: 2927–2934.
26.
SchwartzDGKangSHLynchTS, et al.The anterior deltoid’s importance in reverse shoulder arthroplasty: a cadaveric biomechanical study. J Shoulder Elbow Surg2013; 22: 357–364.
27.
WolfensbergerAVuistinerPKonzelmannM, et al.Clinician and patient-reported outcomes are associated with psychological factors in patients with chronic shoulder pain. Clin Orthop Relat Res2016; 474: 2030–2039.
28.
ThorpeAMO’SullivanPBMitchellT, et al.Are psychologic factors associated with shoulder scores after rotator cuff surgery?Clin Orthop Relat Res2018; 476: 2062–2073.
29.
MakhniECSwartESteinhausME, et al.Cost-effectiveness of reverse total shoulder arthroplasty versus arthroscopic rotator cuff repair for symptomatic large and massive rotator cuff tears. Arthroscopy2016; 32: 1771–1780.
