Do partial rotator cuff tears limit the indication for anatomic shoulder replacement? A systematic review

Abstract

Background: Anatomic total shoulder arthroplasty (aTSA) is the gold standard for treating glenohumeral osteoarthritis. While there is evidence that a rotator cuff insufficiency can lead to poor outcomes and early failure of the anatomic implant, there is no clear consensus on the use of aTSA in the context of a concomitant partial thickness rotator cuff tear and the related outcomes.Purpose: To systematically review clinical and radiological outcomes, complications, and revision rates of anatomic total shoulder arthroplasty in patients with glenohumeral osteoarthritis and preoperative partial-thickness rotator cuff tears.Methods: A systematic review was performed based on the PRISMA guidelines in PubMed, Scopus, and Cochrane databases. Eligible studies reported clinical and radiological outcomes on patients treated with aTSA with established preoperative partial thickness rotator cuff tear on MRI. Extracted data included demographics, study design, follow-up times, overall clinical and radiological findings and complication rates.Results: Three studies, including 595 patients and 636 shoulders, met the inclusion criteria. Overall, 95 patients (14.9%) had partial-thickness supraspinatus tendon tears (23 men and 72 women), with a mean age of 71.3 years and a mean follow-up ranging from 43 to 69.6 months. Across studies, patients with partial thickness tears showed improvements in functional outcomes and range of motion that were comparable to those without tears or with full thickness tears. One study reported a complication rate of 16%, and a 10.3% revision rate, with no correlation to the rotator cuff status. Osteolytic glenoid changes were observed in 22% of patients with partial tears in one study, though proximal migration was uncommon and led to revision in only one case.Conclusions: Current evidence suggests that aTSA remains a viable treatment providing significant improvements in functional outcomes and range of motion, with complication rates comparable to those without tears. However, the available evidence is scarce and heterogeneous, and certainty is very low. No firm recommendations can be made, and further high-quality studies are needed.What this study adds: This systematic review synthesizes the small and methodologically limited body of evidence on aTSA in patients with glenohumeral osteoarthritis and preoperative partial-thickness tears, and suggests that in carefully selected patients meaningful improvements in pain, function, and range of motion can be achieved, with complication and revision rates that appear comparable to those reported in series without partial tears, although the certainty of this evidence is very low.Potential impacts on research, practice, or policy: These findings support a more individualized approach to implant selection in shoulder arthroplasty, where partial-thickness rotator cuff tears alone are not treated as an absolute contraindication to anatomic designs, and underscore the need for high-quality prospective studies to clarify long-term risks of tear progression and implant failure.Study Design: Systematic reviewLevel of evidence: IVKeywords: Glenohumeral osteoarthritis; Anatomic total shoulder arthroplasty (aTSA); Partial-thickness rotator cuff tear; Supraspinatus tendon tear; Systematic reviewhttps://doi.org/10.70885/hmsj.2026.06.002

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