Nonarthroplasty surgical management of massive irreparable posterosuperior rotator cuff tears: A systematic review and meta-analysis

Introduction: Massive irreparable posterosuperior rotator cuff tears (MRCTs) pose clinical and surgical challenges due to tendon retraction, fatty infiltration, muscle atrophy, and poor tissue quality. Nonarthroplasty options have emerged as alternatives to shoulder arthroplasty. Methods: We conducted a systematic review and meta-analysis of comparative studies evaluating nonarthroplasty surgical treatments for MRCTs. We searched PubMed, LILACS, Scopus, and Google Scholar, including studies with at least 12 months of follow up. Functional outcomes, range of motion, and complication rates were extracted. Risk of bias was assessed using ROBINS-I. Results: Twenty-one studies (n = 1036 patients) were included, evaluating partial repair, tendon transfers, superior capsular reconstruction (SCR), debridement, augmentation, and subacromial balloon spacers. All techniques showed functional improvement and pain reduction. Partial repair showed better external rotation than augmentation. Tendon transfers and SCR yielded similar functional outcomes. Augmentations had the highest complication rate (33%), while debridement the lowest (10%). These findings may reflect differences in baseline pathology severity and the relative complexity of the surgical techniques. Conclusion: Nonarthroplasty surgical options for MRCTs provide significant functional gains and pain relief. No technique demonstrated clear superiority. Overall evidence quality was low, highlighting the need for future high-quality comparative studies to optimize treatment strategies.