JSES - 2026-04-09 - Journal Article; Review
The Impact of an Intact Rotator Cuff on the Outcomes of Reverse Shoulder Arthroplasty: A Meta-Analysis of 20,924 Patients.
Daher M, Ashkar I, Parmar T, Kane L, Satalich JR, Klifto CS, Abboud JA
Topics
Key Takeaway
rTSA for GHOA with intact cuff yields 47% lower revision rate (OR 0.53) and 43% lower overall complication rate (OR 0.57) compared to cuff-deficient indications across 20,924 patients.
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Summary
This PRISMA-compliant meta-analysis compared rTSA outcomes in GHOA patients with intact cuff versus cuff-deficient patients (CTA or isolated RCT without OA) across 12 studies. Intact-cuff GHOA patients demonstrated significantly lower rates of revision (OR 0.53), overall complications (OR 0.57), acromial stress fracture (OR 0.22), infection (OR 0.43), and instability (OR 0.60), plus greater improvement in ASES scores (MD +7.17) and external rotation (MD +12.0°). The ASES difference did not exceed the MCID, limiting the clinical significance of the functional advantage.
Key Limitation
The cuff-deficient group is dominated by CTA patients (15,423 of 16,382), making it impossible to isolate the effect of isolated RCT without OA as a distinct indication, and the ASES functional advantage did not reach MCID, undermining the clinical significance of the patient-reported outcome difference.
Original Abstract
BACKGROUND
While reverse shoulder arthroplasty (rTSA) is commonly utilized for rotator cuff tear arthropathy (RCA), indications have expanded to include, primary glenohumeral osteoarthritis (GHOA) with intact cuff. The presence of an intact cuff may influence outcomes after rTSA because preserved cuff musculature can contribute to shoulder stability, and force which could potentially improve postoperative function and reduce complication rates. However, studies have reported contradictory results on whether or not an intact cuff would provide better outcomes in patients receiving an rTSA.
METHODS
This is a systematic review and Meta-analysis performed according the the PRISMA guidelines. PubMed, Cochrane, Embase, and Google Scholar (pages 1-20) were queried through December 2025. Inclusion criteria consisted of studies comparing the outcomes of rTSA based on whether patients had a diagnosis of GHOA with intact cuff, or had a deficient rotator cuff (i.e. had a diagnosis of rotator cuff tears (RCT) without OA, or CTA). Extracted data included adverse events, improvement in patient reported outcome measures, and improvement in range of motion.
RESULTS
Eleven retrospective articles and one prospective article met the inclusion criteria with 4,542 in the GHOA with intact cuff group and 16,382 in the cuff-deficient group (CTA: 15,423 patients,
RCT
959 patients). Patients undergoing rTSA for GHOA and intact cuff had a lower rate of revisions (Odds-Ratio=0.53; 95% CI: 0.41- 0.68, p<.001; I 2 =0%), overall complications (Odds-Ratio=0.57; 95% CI: 0.46- 0.71, p<.001; I 2 =0%), ASF (Odds-Ratio=0.22; 95% CI: 0.08- 0.59, p=0.003; I 2 =0%), infection (Odds-Ratio=0.43; 95% CI: 0.26- 0.73, p=0.002; I 2 =37%), and instability (Odds-Ratio=0.60; 95% CI: 0.40- 0.90, p=0.01; I 2 =0%). In addition, GHOA patients had a better improvement in both American Shoulder and Elbow Surgeons (ASES) scores (Mean Difference=7.17; 95% CI: 2.13- 12.21, p=0.005; I 2 =81%) without exceeding the MCID, and external rotation (ER) (Mean Difference=12.00 degrees; 95% CI: 9.63- 14.37, p<.001; I 2 =38%).
CONCLUSION
Rotator cuff-deficient patients undergoing rTSA have a higher risk of post-operative complications compared to patients undergoing rTSA for GHOA with an intact cuff. They also showed less improvements in ASES scores and ER. However, the clinical significance of these differences should be interpreted with caution, as not all improvements exceeded established thresholds for clinical importance.