• Leonardo Osti, Lorenzo Milani, Silvana Ferrari, and Nicola Maffulli.
• Unit of Arthroscopy and Sport Medicine, Hesperia Hospital, Via Arqua', 41125 Modena, Italy.
• Br. Med. Bull. 2021 Sep 10; 139 (1): 59-72.

IntroductionThis systematic review evaluated and compared the use of a subacromial spacer implantation (SSI) with arthroscopic superior capsular repair (ASCR) in the management of massive irreparable rotator cuff tears (MIRCTs) with an assessment of clinical and imaging outcomes.Sources Of DataThis systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched in PubMed, Medline and Embase database literature using the keywords 'subacromial spacer', 'subacromial balloon', 'subacromial device', 'arthroscopy', 'superior capsular reconstruction', 'irreparable rotator cuff tears', 'satisfaction' and 'quality of life'.Areas Of AgreementWe included a total of 29 articles (14 about SSI and 15 about ASCR) dealing with outcomes, satisfaction and patients' quality of life.Areas Of ControversyThe use of a subacromial spacer showed similar results in terms of patients' satisfaction and quality of life when compared with ASCR.Growing PointsSSI can be implanted quickly and has a low complication rate. It can therefore be considered a good alternative for the management of MIRCTs.Areas Timely For Developing ResearchThe subacromial spacer is a biodegradable implant easily implanted at arthroscopy. It can lead good clinical and imaging outcomes in MIRCTs. Similarly, ASCR can be performed with either an autograft or synthetic allograft transplantation, with satisfactory results. Long-term prospective studies are needed to compare SSI and ASCR to verify their effectiveness.© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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