How to Optimize Reverse Shoulder Arthroplasty for Irreparable Cuff Tears

Reverse shoulder arthroplasty (RSA) is commonly considered as one of the options for surgical management of the functionally irreparable rotator cuff tear (FIRCT). This article reviews tips and tricks to optimize the outcome of RSA when performed specifically for this indication.

RSA has been reported to provide satisfactory outcomes in a large proportion of patients with FIRCTs. However, subjective satisfaction is lesser in patients with well-maintained preoperative motion as well as those with isolated loss of active external rotation. The popularity of implants that provide some degree of global lateralization continues to increase. Optimizing the outcome of RSA for FIRCTs requires a careful balance between minimizing perimeter impingement and enhancing the function of intact muscles, in particular the deltoid and any remaining rotator cuff. Controversy continues regarding the benefits and disadvantages of subscapularis repair at the time of RSA. Tendon and muscle transfers performed at the time of RSA have the potential to optimize the outcome in selected patients with profound weakness in external rotation or those with severe deltoid dysfunction.

When RSA is considered for patients with a FIRCT without arthritis, careful attention to indications and technical pearls may contribute to optimize outcomes.