Clinical Outcomes and Complications of Superior Capsular Reconstruction Versus Reverse Shoulder Arthroplasty for Massive Rotator Cuff Tears: A Meta-Analysis.

BACKGROUND

Irreparable rotator cuff tears without advanced arthritis are difficult to manage. Superior capsular reconstruction (SCR) preserves the native joint, while reverse total shoulder arthroplasty (rTSA) offers reliable function but with higher implant-related risks, especially in younger patients. This study compared outcomes and complications between SCR and rTSA.

METHODS

This study was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, Scopus, and Ovid Medline were searched from inception to May 2, 2025, for studies directly comparing SCR and rTSA in patients with irreparable rotator cuff tears without advanced arthritis. Eligible studies were required to report at least 1 of the following outcomes: patient-reported outcome scores, shoulder range of motion, or postoperative complications. Outcomes of interest included patient-reported outcomes, shoulder range of motion, and postoperative complications.

RESULTS

Seven level III studies involving 257 patients in the SCR group (age, 54.2-73.6 years; follow-up, 2.1-51.6 months) and 173 in the rTSA group (age, 63-77 years; follow-up, 24-48.3 months) met inclusion criteria. Meta-analysis showed no statistically significant differences between SCR and rTSA in American Shoulder and Elbow Surgeons scores (mean difference [MD] = 1.66; 95% CI, -3.44 to 6.77; p = 0.520), pain visual analog scale (MD = 0.16; 95% CI, -0.63 to 0.95; p = 0.690), or any range of motion parameters, including abduction, forward flexion, external rotation, and internal rotation. However, SCR demonstrated a statistically significantly lower overall complication rate compared to rTSA (3.5% vs. 10.8%; odds ratio, 0.32; p = 0.020). Complications following SCR were mainly graft- or tendon-related, whereas those after rTSA were typically mechanical or bone-related, including scapular notching, acromial fracture, and implant loosening.

CONCLUSIONS

At short- to midterm follow-up, SCR provides similar clinical outcomes to rTSA in patients with irreparable rotator cuff tears without advanced arthritis. However, the complication rate was higher in the rTSA group. Complications following SCR were primarily graft- or tendon-related, whereas rTSA complications were more often mechanical or bone-related.