To evaluate the effect of various surgical procedures on the treatment of patients with irreparable rotator cuff tears (IRCTs) using a network meta-analysis.

PubMed, Excerpta Medica Database (Embase), Google Scholar, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP) and Wanfang Database were searched from the inception to October 2022 to search for randomised controlled trials and cohort studies of surgical procedures in treatment of IRCTs. Repeat publication and literatures without shoulder function scores were excluded. Risk assessment of the included randomised controlled trials was conducted using the risk of bias assessment tool recommended by the Cochrane Manual. The Newcastle-Ottawa scale was used for risk assessment of cohort studies. Data were analysed and plotted by Stata 15.0 software.

A total of 17 studies which involved 10 surgical procedures and 2 123 patients were included in this study. According to the surface under the cumulative ranking curve (SUCRA) of standardised shoulder function scores, probability ranking in descending order is: tendon transfer with partial repair (SUCRA=91.2)>tendon transfer (SUCRA=81.1)>reverse shoulder arthroplasty (SUCRA=75.7) >superior capsular reconstruction (SUCRA=70.7)>rotator cuff patch (SUCRA=65.8)>partial repair (SUCRA=46.5)>debridement with myotenotomy or tenodesis of the biceps tendons (SUCRA=21.9)>debridement (SUCRA=19.4)>subacromial InSpace balloon implantation with myotenotomy or tenodesis of the biceps tendons (SUCRA=15.1)>subacromial InSpace balloon implantation (SUCRA=12.6).

This study has revealed that the tendon transfer with partial repair would deliver the best surgical outcome of an irreparable rotator cuff tear, however, the InSpace subacromial procedure delivered the worst. Further studies with multicentre and randomised controlled trials in large samples are required to find out the best possible surgical procedures in treatment of an irreparable rotator cuff tear.