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J Shoulder Elbow Surg. 2017 Sep;26(9):e265-e277. doi: 10.1016/j.jse.2017.03.039. Epub 2017 Jul 3.

Reverse shoulder arthroplasty for irreparable massive rotator cuff tears: a systematic review with meta-analysis and meta-regression.

Author information

1
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Orthopaedics Department, Hospital de Braga and Hospital Privado de Braga, Braga, Portugal; Clínica Espregueira-Mendes, FIFA Medical Centre of Excellence, Estádio do Dragão, Porto, Portugal. Electronic address: nunosevivas@med.uminho.pt.
2
Orthopaedics Department, Hospital de Braga and Hospital Privado de Braga, Braga, Portugal; Clínica Espregueira-Mendes, FIFA Medical Centre of Excellence, Estádio do Dragão, Porto, Portugal.
3
Clínica Espregueira-Mendes, FIFA Medical Centre of Excellence, Estádio do Dragão, Porto, Portugal.
4
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
5
Pathology Department, Hospital de São João, Porto, Portugal.
6
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Orthopaedics Department, Hospital de Braga and Hospital Privado de Braga, Braga, Portugal; Clínica Espregueira-Mendes, FIFA Medical Centre of Excellence, Estádio do Dragão, Porto, Portugal.
7
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Clínica Espregueira-Mendes, FIFA Medical Centre of Excellence, Estádio do Dragão, Porto, Portugal; 3B's Research Group, Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Caldas das Taipas, Guimarães, Portugal.

Abstract

BACKGROUND:

Massive rotator cuff tears (MRCTs) are very large tears that are often associated with an uncertain prognosis. Indeed, some MRCTs even without osteoarthritis are considered irreparable, and nonanatomic solutions are needed to improve the patient's symptoms. Reverse shoulder arthroplasty (RSA) is an option that can provide a more predictable pain relief and recovery of function. Nonetheless, outcomes after RSA for irreparable MRCTs have not been well defined. The aim of this study was to quantitatively aggregate the findings associated with the use of RSA in this subset of patients and analyze the effect on patient functional status and pain.

METHODS:

A comprehensive search was performed until October 2015 using MEDLINE, Scopus, Cochrane Database of Systematic Reviews, and Central Register of Controlled Trials databases. Studies that assessed the outcomes of RSA in patients with irreparable MRCT without osteoarthritis (with at least 2 years of follow-up) were included. If the results of MRCT without osteoarthritis were not possible to subgroup, the study was excluded. Methodologic quality was assessed using the Coleman Methodology Score.

RESULTS:

Included were 6 studies (266 shoulders) with a follow-up ranging from 24 to 61.4 months. The mean Coleman Methodology Score was 58.2 ± 11.8 points. There was an overall improvement from preoperative to postoperative assessments of the clinical score (Cohen d = 1.35, P < .001), forward flexion (d = 0.50, P = .009), external rotation (d = 0.40, P < .001), function (d = 1.04, P < .001), and pain (d = -0.89, P < .001).

CONCLUSION:

Patients with irreparable MRCT without presence of osteoarthritis have a high likelihood of achieving a painless shoulder and functional improvements after RSA.

KEYWORDS:

Massive; chronic; irreparable; pseudoparalytic shoulder; reverse shoulder arthroplasty; rotator cuff tears

PMID:
28684233
DOI:
10.1016/j.jse.2017.03.039
[Indexed for MEDLINE]

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