These authors conducted a retrospective multi-institutional study (22 institutions, 24 surgeons) of 203 patients (average age, 71years) who underwent reverse total shoulder (RTSA) for massive irreparable rotator cuff tears (MIRCT) without glenohumeral arthritis after a mean follow-up of 50 months. Patients were divided into four groups based on preoperative shoulder active forward elevation (aFE) (<60 degrees, <90, ≥90, >120).
Patients in each group had significant improvements in patient reported outcomes and range of motion. .
The complication rate was 1.6% and the reoperation rate was 1.1%).
The greatest improvement in patient reported outcomes were for the patient with pseudoparalysis (aFE <90) in comparison to the non-pseudoparalytic group (aFE ≥ 90) (SPADI score (-62.23 vs. -49.18, p<.01), UCLA score (+17.25 vs. +13.47, p<.01), CS (+38.02 vs. +20.57, p<.01), and the SST score (+6.29 vs. +4.82, p<.01).
Significantly greater improvements in abduction and forward elevation were noted in the pseudoparalytic group compared to the non-pseudoparalytic group.
While patient satisfaction was highest in the group with >120 degrees of preoperative active forward elevation, these patients experienced a non-significant decrease of (-5.45 degrees) in forward elevation.
Comment: Since almost all massive irreparable cuff tears are chronic, these patients have the opportunity to try to improve the comfort and function of their shoulder using gentle stretching and strengthening exercises (see this link).
This study indicates that the value of the reverse total shoulder to the patient (value = improvement in patient reported outcome divided by cost of the implant and procedure) is greatest for patients with pseudoparalysis.
For those patients with massive irreparable cuff tears and preserved active elevation, other less costly and less invasive procedures, such as the smooth and move (see this link) may merit consideration.
Depending on patient goals and the condition of the shoulder, other options for managing irreparable cuff tears include partial repair, tendon transfer, and superior capsular reconstruction.
