A Systematic Review of Shoulder Joint Surgeries to Solve Instability and Pain Due to Irreparable Tears of Subscapularis and Supraspinatus Without Arthritis.

Background/Objectives: Shoulder pain or instability have different causes and therefore different treatment approaches. The most common are surgical approaches, ranging from more conservative to more radical, such as arthroplasty. In the presence of irreparable rupture or tears of the supraspinatus and subscapularis muscles, particularly in younger patients without arthritis or osteoarthrosis, it becomes a surgical challenge to avoid early arthroplasty. Despite the development and proposal of various surgical techniques to restore stability and function, and eliminate pain of the glenohumeral joint, there remains a lack of consensus on the most effective approach in the absence of arthritis. This work aims to systematically review the available evidence on surgical procedures for treating shoulder joint instability and pain due to irreparable subscapularis and supraspinatus tendon tears, excluding cases with coexisting arthritis or arthrosis. Methods: This systematic review was conducted following PRISMA 2020 guidelines. Search was performed across the major databases PubMed, Scopus, and Web of Science, up to 2025. Inclusion criteria comprised clinical studies (randomised controlled trials, cohort studies, case series), reviews and systematic reviews reporting on surgical interventions for shoulder instability and pain caused by irreparable tears of the subscapularis and supraspinatus in patients without degenerative joint disease. As shoulder surgery techniques have been continually evolving since the early procedures, no lower limit was set for the time interval. The related literature that was not identified in the mentioned databases was added manually through parallel searches of associated themes and suggestions from the websites of those databases. To be eligible, papers had to describe shoulder instability surgery, surgical techniques, indications, and patients' recovery outcomes. The key tasks, such as title and abstract screening, were performed by V. M., L. R., and M. A. N. to ensure thoroughness and reduce bias. Results: From an initial search result of 98 works, a total of 66 titles and abstracts were analysed, resulting in a final selection of 24 studies that fulfilled the mentioned criteria and were therefore included in this review. The oldest paper mentioning a shoulder surgery in this context was published in 2003. The most frequently described procedures included total joint replacement, tendon transfers, Superior Capsule Reconstruction, partial rotator cuff repair and others. Across studies, improvements were noted in shoulder stability, range of motion, and functional scores. However, heterogeneity in surgical techniques and outcome measures limited direct comparison. Conclusions: The conducted systematic review reveals an important gap and highlights the need to evolve beyond traditional shoulder surgery techniques and, if possible, to provide a single solution for the different origins of shoulder instability. Several surgical options demonstrate promising outcomes in managing shoulder instability and pain due to irreparable subscapularis and supraspinatus tears in patients without glenohumeral arthritis. However, those procedures are associated with anatomical changes in the shoulder joint, compromising the joint's full function and prolonging recovery time. Nevertheless, this conclusion is based on a small sample size of the current literature and a lack of high-level evidence. Further comparative and long-term studies are needed to establish optimal treatment strategies.