Comparative Review of Superior Capsule Reconstruction and Reverse Shoulder Arthroplasty for Irreparable Rotator Cuff Tear

Rotator cuff tears are a prevalent cause of shoulder dysfunction, particularly in aging populations, with conservative treatments often proving ineffective for massive or irreparable tears. When non-surgical options fail, superior capsule reconstruction (SCR) and reverse shoulder arthroplasty (RSA) are two primary surgical techniques utilized to restore shoulder function. SCR involves reconstructing the superior capsule using a graft to stabilize the glenohumeral joint and maintain native biomechanics. Conversely, RSA replaces the joint with a prosthetic system, altering shoulder mechanics to improve mobility and pain relief. While SCR preserves natural anatomy and is associated with positive functional outcomes, it presents challenges, including graft integrity issues and a high failure rate. RSA offers reliable pain relief and functional improvements, particularly in elderly patients, but is associated with complications such as implant loosening and scapular notching. This review explores the indications, surgical techniques, clinical outcomes, limitations, and cost-effectiveness of SCR and RSA for the treatment of irreparable rotator cuff tears. Studies indicate that while both procedures improve function and reduce pain, RSA generally provides more consistent long-term outcomes. In contrast, SCR may be preferable for younger, active patients seeking to delay arthroplasty. Additionally, cost considerations may influence surgical decisions: SCR is less invasive but may require revision surgery, whereas RSA entails higher initial costs but offers greater durability. By comparing these techniques, this review aims to aid in treatment selection based on patient-specific factors, such as age, activity level, and surgical risk.