Does robust greater tuberosity repair affect the outcomes of reverse shoulder replacement in proximal humerus fractures? – A Bayesian network meta-analysis

Background Proximal humerus fractures are common in older adults, and the role of greater tuberosity (GT) repair in reverse shoulder arthroplasty (RSA) remains debated. Some surgeons omit GT repair to simplify surgery, but the functional impact of not repairing it is unclear. This study compared outcomes of healed GT repair, non-healed repair, and no repair. Methods A Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA)-compliant systematic review and meta-analysis (MEDLINE, Embase, Cochrane; inception – February 2025) included 20 Methodological Index for Non-Randomised Studies (MINORS)-appraised studies. Outcomes were Constant score and shoulder motion. Analyses comprised: (a) a frequentist network meta-analysis of healed, non-healed, and no repair; and (b) a Bayesian comparison of any repair versus no repair. Results Among 1885 patients, healed repair produced higher Constant scores and better abduction, external rotation, and forward flexion than non-healed or no repair. Non-healed repair and no repair showed similar outcomes. Bayesian analysis confirmed functional benefits of GT repair. Implant type had no effect. Conclusions GT repair improves postoperative function after RSA, with maximal benefit when healing occurs.