Functional Outcomes Following Reverse Total Shoulder Arthroplasty with versus Without Subscapularis Tendon Repair

Abstract

Background: Reverse total shoulder arthroplasty (RTSA) is one of the most important procedures in the management of several shoulder pathologies. Following advances in these procedures, the question was raised whether repairing the subscapularis tendon provides superior functional results compared to leaving it unrepaired following RTSA, with contemporary clinical studies providing conflicting findings. Objective: To compare the clinical and functional outcomes of reversed total shoulder arthroplasty (RTSA) performed with versus without subscapularis tendon repair in Iraqi patients. Methods: Twenty-eight patients scheduled for RTSA, in whom the decision to repair the subscapularis tendon was made intraoperatively according to the operating surgeon’s judgment, were evaluated at baseline preoperatively and at 6-month and 12-month intervals postoperatively using the Constant-Murley score and shoulder range of motion. The final analysis included 12 patients in the tendon repair group and 16 patients in the non-repair group. Results: Both groups demonstrated significant improvements in Constant-Murley Score (CMS) and shoulder range of motion throughout follow-up (all p<0.001). No significant between-group differences were observed at baseline, 6 months, or 12 months for any functional or range-of-motion outcome (p>0.05). However, repeated-measures analysis showed significantly faster recovery trajectories in the repair group for CMS, forward flexion, abduction, and internal rotation (time/group interaction, all p<0.001), whereas external rotation improved similarly regardless of repair status (p=0.595). Conclusions: Subscapularis repair in RTSA, when technically feasible, may facilitate earlier functional recovery without significantly altering 12-month clinical outcomes.