The impact of an intact rotator cuff on the outcomes of reverse shoulder arthroplasty: a meta-analysis of 20,924 patients.
Mohammad Daher, Imad Ashkar, Tarishi Parmar et al.
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In 30 seconds
This systematic review and meta-analysis compared reverse shoulder arthroplasty outcomes in patients with glenohumeral osteoarthritis and an intact rotator cuff versus patients with cuff deficiency. It included 12 studies—11 retrospective and one prospective—with 4,542 patients in the intact-cuff group and 16,382 in the cuff-deficient group. Intact-cuff patients had lower odds of revision (OR 0.53; 95% CI 0.41-0.68) and overall complications (OR 0.57; 95% CI 0.46-0.71). They also had greater improvement in shoulder scores and external rotation, although the score difference did not exceed the minimal clinically important difference.
Key findings
- Revision odds were lower with intact-cuff glenohumeral osteoarthritis than with cuff deficiency (OR 0.53; 95% CI 0.41-0.68, P < .001).
- Overall complication odds were lower in the intact-cuff group (OR 0.57; 95% CI 0.46-0.71, P < .001).
- The intact-cuff group had greater improvement in American Shoulder and Elbow Surgeons scores (mean difference 7.17; 95% CI 2.13-12.21), below the minimal clinically important difference.
- External rotation improvement was greater in the intact-cuff group (mean difference 12.00°; 95% CI 9.63-14.37, P < .001).
Why it matters
The findings suggest that outcomes after reverse shoulder arthroplasty differ according to cuff status and underlying diagnosis. Lower complication and revision odds in the intact-cuff group may help frame discussions of expected outcomes, while the modest score improvement and the authors’ caution about clinical importance argue against treating statistical differences as necessarily meaningful to patients.
What to keep in mind
The evidence was predominantly retrospective, and heterogeneity was substantial for improvement in American Shoulder and Elbow Surgeons scores (I 2 = 81%). The authors caution that not all outcome differences exceeded thresholds for clinical importance.