Subscapularis repair in reverse shoulder arthroplasty: a systematic review and meta-analysis with a sub-analysis by implant lateralization and repair techniques.
Mohammad Daher, Peter Boufadel, Miguel Fiandeiro et al.
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In 30 seconds
This systematic review and meta-analysis compared reverse total shoulder arthroplasty outcomes with versus without subscapularis repair, including analyses by implant design and repair technique. Nineteen articles representing 18 cohorts included 1,698 patients with repair and 1,284 without. Overall, repair was associated with lower odds of instability (odds ratio = 0.26, P < .001), alongside better pain and internal-rotation improvement. Benefits were more evident with medialized implants; the authors reported minimal benefits with lateralized implants, although pain improvement favored repair in both design subgroups.
Key findings
- Repair was associated with lower instability odds overall (odds ratio = 0.26, P < .001).
- In medialized implants, repair was associated with lower complication odds (odds ratio = 0.10, P < .001) and instability odds (odds ratio = 0.06, P < .001).
- Pain improvement favored repair in both medialized and lateralized implant subgroups; internal-rotation improvement did not differ in the lateralized subgroup.
- Technique-specific analyses found better internal-rotation improvement with tendon-to-tendon repair (standardized mean difference = 0.52, P < .001) and better patient-reported outcome improvement with trans-osseous repair.
Why it matters
Subscapularis repair may not have uniform value across reverse shoulder arthroplasty designs or repair methods. The findings suggest that implant lateralization and technique could influence instability, pain, and motion outcomes, helping frame surgical decision-making and the questions that future comparative studies should address.
What to keep in mind
The evidence was synthesized from comparative cohorts rather than a stated randomized trial, so associations may be affected by differences between patients or studies. The abstract does not report follow-up duration or study-level quality.