Comparison of Clinical Outcomes Between Arthroscopic Rotator Cuff Repair and Reverse Total Shoulder Arthroplasty in Patients With Massive Rotator Cuff Tears and High-Grade Fatty Atrophy Without Glenohumeral Osteoarthritis.

Background: Despite the effectiveness of reverse total shoulder arthroplasty (RSA) and arthroscopic rotator cuff repair (ARCR) for treating massive rotator cuff tears (MRCTs), controversies remain in patients without glenohumeral osteoarthritis (GHOA). Purpose: To compare clinical outcomes of ARCR or RSA in patients with MRCT with high-grade fatty atrophy without GHOA. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective study on patients with MRCTs without GHOA and with grades 3 or 4 Goutallier muscle changes who underwent ARCR or RSA, with a minimum 2-year follow-up. Range of motion (ROM) and patient-reported outcomes (PROs) were collected-including visual analog scale for pain, American Shoulder and Elbow Surgeons score, Veterans Rand 12-Item Health survey, and Subjective Shoulder Value. Postoperative results were compared based on rotator cuff tendon healing in the ARCR group. Results: A total of 81 patients met the study criteria-56 underwent ARCR and 25 underwent RSA. Patients in the RSA (age, 71.7 ± 7.7 years) group were older than those in the ARCR (age, 66.7 ± 7.4 years) group ( Conclusion: Both ARCR and RSA improved functional outcomes in patients with MRCT without GHOA. While healing was moderate after ARCR, the postoperative ROM was greater after ARCR compared with RSA in appropriately selected patients. Moreover, healed rotator cuffs demonstrated improved postoperative FF compared with unhealed repairs.