الفهرس 
Overview to massive Irreparable Rotator Cuff TearsOnly 14 pages are availabe for public view
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Abstract
Background: rotator cuff pathology is one of the most common sources of shoulder disability and among the prevalent conditions treated by orthopaedic surgeons. Irreparable rotator cuff tear is generally large tear (in both anterior-posterior and medial-lateral dimensions) and retracted with poor attenuated tissue quality, muscular atrophy and fatty infiltiration.
Aim of the Work: to conduct a systematic review about superior capsular reconstruction Versus reversed total shoulder arthroplasty in treatment of massive irreparable rotator cuff tears aiming to reach a conclusion regarding superiority of one technique over the other. We may then present recommendations to orthopaedic surgeons to facilitate decision-making when approaching such cases.
Patients and Methods: this systematic review will be performed following the preferred reporting items for systematic reviews meta-analysis (Prisma). Six guided items and check list to answer the question of: comparison study between superior capsular reconstruction and reversed total shoulder arthroplasty in treatment of massive irreparable rotator cuff tear. Patients with irreparable rotator cuff tear of both gender and patients older than 18 years.
Results: all outcomes showed improvement in all studies either clinically and radiologically, also all studies had low complications rate as the following with variation of significance and heterogenicity between each group of studies. The mean age of patients underwent SCR was 64.7 ± 5.89 years, while for patients underwent RTSA; the mean age was 68.1 ± 22.18 years with metanalysis between the two groups; showing significant difference between them (p-value:0.0001) as the SCR operation was decided for age group younger than patients underwent RTSA with mean difference 5.24 (95% CI [ 2.57, 7.9] ) years. The results agreed with Lim et al. 58 as they considered the risk of re-tears with SCR was significantly higher for patients ≥ 70 years of age.
Conclusion: based on the evidence presented, both SCR and RTSA showed significant improvement in post-operative outcome measures in management of MIRCTs. All outcome measures showed comparable results with both SCR and RTSA except in JOA score and constant score, both showed significant improvement favoring RTSA. RTSA was the preferred choice for elderly patients with higher grade of glenohumeral arthritis and it was the most common revision surgery after failed SCR. It is preferred to mention SCR as the joint preserving surgical technique and that is why it would be the preferred technique in young age patients with relative lower grades of glenohumeral arthritis.