Rotator Cuff Consensus Part III: Reverse Total Shoulder Arthroplasty, Revisions, Rehabilitation, and Follow-Up-An International Consensus Expert Statement.

PURPOSE: To establish updated international consensus statements on reverse total shoulder arthroplasty, revision surgery, and rehabilitation, return to play, and follow-up for rotator cuff tears, reflecting new evidence, evolving techniques, and ongoing areas of controversy.

METHODS

A consensus process on the treatment of rotator cuff tears was conducted, with 97 shoulder/sports surgeons from 15 countries participating. There were 9 specific subtopics (1) Diagnosis, (2) Nonoperative Management, (3) Repair of Posterosuperior Tears, (4) Subscapularis Repair, (5) Graft/Patch Augmentation and Superior Capsular Reconstruction, (6) Tendon Transfers, (7) Reverse Total Shoulder Arthroplasty, (8) Revision Surgery, and (9) Rehabilitation, Return to Play, and Follow-up. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement.

RESULTS

Of the 47 consensus statements, 1 achieved unanimous consensus, 33 achieved strong consensus, 10 achieved consensus, and 3 did not achieve any level of consensus.

CONCLUSIONS

There was consensus that reverse shoulder arthroplasty is indicated for patients with irreparable tears, pseudoparalysis, or failed prior repairs with pain and dysfunction, whereas contraindications include inadequate deltoid or axillary nerve function and active infection. In the revision setting, consensus supported a structured approach emphasizing careful assessment of tissue quality, bone stock, stiffness, and expectations, with agreement on the prognostic relevance of prior surgeries in determining the optimal reconstructive strategy. For rehabilitation and return to play, the panel agreed that no universal timeline exists; instead, clearance should be based on restoration of strength, range of motion, proprioception, pain resolution, and psychological readiness. There was variability in recommended follow-up schedules and the role of routine imaging, with no agreement on the ideal surveillance protocol.

LEVEL OF EVIDENCE: Level V, expert opinion.