Functional Outcomes in Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction Versus Reverse Shoulder Arthroplasty: Meta-Analysis

Background: Irreparable rotator cuffs continue to pose a dilemma for orthopedic surgeons, despite multiple effective management strategies. The basis of this review is to assess the functional outcomes of two preferred options for irreparable rotator cuffs comparing superior capsular reconstruction (SCR) to reverse shoulder arthroplasty (RSA) in older adults following an irreparable rotator cuff tear. Methods: A systematic review and meta-analysis was conducted utilizing the PRISMA 2020 guidelines. The search yielded 99 results, after excluding duplications and abstract screening, 12 were selected for full-text review. Included were randomized controlled trials published from 01-01-2019 to 12-01-2023 using American Shoulder and Elbow Surgeons (ASES) scores to assess function at baseline and twelve months follow-up. Five studies were included totaling 205 participants. Mean and standard deviation were extracted to perform a random-effects meta-analysis using SPSS and to report pooled averages. Results: Mean ASES in the SCR group went from 42.6(±18.5) to 73.0(±19.2) while the RSA group saw a change from 42.3(±19.8) to 79.1(±14.7). Significant and large improvements in effect size were seen pre-post in the RSA group (p<.01, Cohen's d= 2.07[0.14,1.80] but not the SCR group (p= 0.25, Cohen's d= 2.07 [0.14,1.80]. No significant differences were found in subgroup analysis (p= 0.86). Conclusion: Large heterogeneity was present in the SCR group (I2=97.7%) resulting in a lack of statistical significance compared to the consistent but similar average improvements found in the RSA group (I2=0%). More high-quality research is required to confirm these observations and guide optimal management for irreparable rotator cuff tears in older adults.