Variable Return-to-Sport Rates Despite Improved Shoulder Function and Outcomes Scores After Primary Reverse Shoulder Arthroplasty in Active Patients: A Systematic Review

Background: The surgical indications for reverse shoulder arthroplasty (RSA) have continued to expand as it continues to be effective in restoring functionality in older, less active populations. The effect of RSA on return to sport (RTS) in the athletic population has been sparsely studied. Purpose: To systematically review the RTS rate after primary RSA. Study Design: Systematic review; Level of evidence, 4. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the PubMed, Embase, and Web of Science online databases was conducted and included articles published from database inception until December 22, 2024. Inclusion criteria consisted of studies reporting on RTS after primary RSA. Rates of RTS or activity were collected. Patient-reported outcome measures (PROMs) and range of motion (ROM) data were collected when available. Delta values, the change from preoperative to postoperative values, were calculated for each PROM and ROM when available. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: Overall, 15 studies reporting on a total of 937 patients (954 shoulders) were included in this review. Mean patient age was 72.7 years (range, 68.0-76.5 years), and 58.1% were female. Mean follow-up was 40.5 months (range, 31.6-57.6 months). The RTS for the studies ranged from 48% to 100%. Swimming (n = 188 athletes) was the most reported sport, followed by golf (n = 151 athletes). Sport-specific RTS rates ranged from 50% to 100% for golf and 64% to 67% for swimming. Patients returned to a higher level of performance 11% to 74% of the time. Postoperative delta values ranged from −7 to −2.1 for the visual analog scale for pain (VAS Pain) during sport, −6.1 to −3 for VAS Pain, 24.4 to 59 for the American Shoulder and Elbow Surgeons score, and 3.8 to 8 for the Simple Shoulder Test. The mean MINORS score of the included studies was 16.8 (range, 16-19) for comparative studies and 10.0 (range, 9-11) for noncomparative studies. Conclusion: Our study showed that primary RSA allows for variable rates of RTS ranging from 48% to 100%, with 50% to 100% of patients returning to golf and 64% to 67% returning to swimming. Overall, patients reported improved postoperative outcomes scores and range of motion.