Why the study?
Does bridging allograft reconstruction improve functional outcomes and reduce complications compared to reverse shoulder arthroplasty in patients with massive, irreparable rotator cuff tears?
Does bridging allograft reconstruction improve functional outcomes and reduce complications compared to reverse shoulder arthroplasty in patients with massive, irreparable rotator cuff tears?
Bridging allograft reconstruction offers comparable functional outcomes with fewer complications compared with reverse shoulder arthroplasty for massive, irreparable rotator cuff tears, particularly avoiding the heightened risks seen with RSA in patients under 70.
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Supports BAR preference to minimize complications in massive irreparable tears; extends Level 1 evidence favoring reconstruction over RSA.
Bridging allograft reconstruction (BAR) and reverse shoulder arthroplasty (RSA) are 2 approaches for managing massive, irreparable rotator cuff tears, both yielding satisfactory functional results. A systematic review of 28 studies encompassing 1125 cases treated with either technique revealed significant improvement in range of motion and functional scores across all patients. However, BAR led to a notably greater improvement in external rotation. RSA exhibited significantly higher complication rates (18.6%) and an increased likelihood of reoperation (7.9%). Patients younger than 70 undergoing RSA faced higher complication and reoperation risks at 26% and 12.5%, respectively. In summary, BAR offers comparable functional outcomes with fewer complications compared with RSA for managing massive, irreparable rotator cuff tears. Patients under age 70 being considered for RSA should understand their heightened risks.
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Kelly et al. (2025) studied this question.
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