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Patients with an intact subscapularis and preserved forward elevation are challenging to treat because there is not a consensus treatment algorithm. For low\u2010demand, elderly patients, several subacromial surgical options are available that can provide pain relief without the risks or burden of rehabilitation posed by reverse total shoulder arthroplasty or a complex soft\u2010tissue reconstruction (e.g., superior capsular reconstruction, tendon transfer, bridging grafts). Debridement, more specifically the \u201csmooth\u2010and\u2010move\u201d procedure, offers a reliable outcome with documented improvements in pain and function at long\u2010term follow\u2010up. Similarly, the biodegradable subacromial balloon spacer (InSpace; Stryker, Kalamazoo, MI) has been shown to significantly improve pain and function in patients who are not responsive to nonoperative treatment. Disease progression with these options is possible, with a small percentage of patients progressing to rotator cuff arthropathy. Biologic tuberoplasty and bursal acromial reconstruction are conceptually similar to the balloon spacer but instead use biologic grafts to prevent bone\u2010to\u2010bone contact between the humeral head and the acromion. Although there is no single gold standard treatment, the variety of surgical techniques allows patients and surgeons to effectively manage these challenging situations.<\/jats:p>","DOI":"10.1016\/j.arthro.2024.02.003","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T15:10:18Z","timestamp":1714749018000},"page":"1394-1396","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":5,"title":["Subacromial Surgery for Irreparable Posterosuperior Rotator Cuff Tears"],"prefix":"10.1002","volume":"40","author":[{"given":"Matthew D.","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery University of Texas Health Science Center Houston Houston Texas U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clayton W.","family":"Nuelle","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Missouri Columbia Missouri U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert U.","family":"Hartzler","sequence":"additional","affiliation":[{"name":"Burkhart Research Institute for Orthopaedics (BRIO) San Antonio Texas U.S.A."},{"name":"TSAOG Orthopaedics San Antonio, Texas San Antonio Texas U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,5,1]]},"reference":[{"key":"e_1_2_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2022.02.020"},{"key":"e_1_2_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2021.07.021"},{"key":"e_1_2_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2020.02.018"},{"key":"e_1_2_3_5_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.00122"},{"key":"e_1_2_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-017-3486-2"},{"key":"e_1_2_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2012.10.022"},{"key":"e_1_2_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967119863432"},{"key":"e_1_2_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2022.06.033"},{"key":"e_1_2_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2015.07.025"},{"key":"e_1_2_3_11_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.21.00667"}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S074980632400121X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S074980632400121X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2024.02.003","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.arthro.2024.02.003","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2024.02.003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T09:07:33Z","timestamp":1773565653000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.arthro.2024.02.003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5]]},"references-count":10,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1016\/j.arthro.2024.02.003"],"URL":"https:\/\/doi.org\/10.1016\/j.arthro.2024.02.003","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Subacromial Surgery for Irreparable Posterosuperior Rotator Cuff Tears","name":"articletitle","label":"Article Title"},{"value":"Arthroscopy: The Journal of Arthroscopic & Related Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.arthro.2024.02.003","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2024 by the Arthroscopy Association of North America","name":"copyright","label":"Copyright"}]}}