Reverse Shoulder Arthroplasty for Massive Rotator Cuff Tears

The purpose of this review is to explore, the role of reverse shoulder arthroplasty (RSA) in substituting cuff dysfunction, indications, reported outcomes in the literature and surgical technique for treating patients with massive cuff tear (MCT) without gleno-humeral arthritis. Undoubtedly, the RSA is a well-accepted treatment for cuff tear arthropathy, but is there a place for a prosthesis to treat a tendinous disease? Moreover, if there is no debate to implant an RSA in an elderly, low-demand patient with a massive, retracted, irreparable cuff tear, what is the place of RSA in a young, active patient with an acceptable preoperative function when there is no other treatment? Young age and good preop function are debatable indications for RSA despite good and sustainable results at ten years of follow up. So, treatment of MCT must be adapted to each situation. RSA is not for everybody and there is a place for other treatments. When the indication is well selected and the technique precise, RSA provides, in a large majority of patients, a pain-free, improved shoulder with durable results.