Simovitch R, et al. - Three hundred and twenty-four reverse total shoulder arthroplasty (rTSA) subjects with 5 years of minimum follow-up were recruited in a study and analyzed by the researchers in order to perform a sufficiently statistically powered assessment to quantify the influence of scapular notching on midterm rTSA outcomes. Forty-seven (14.5%) subjects had scapular notching with the average notching grade of 1.7 ± 0.8. The average time to notch development was observed as 51.4 ± 24.1 months, and at 49.0 ± 22.1 months, 57.5 ± 22.6 months, and 71.6 ± 15.8 months, grade 1, grade 2, and grade 3 notches had developed, respectively. No preoperative variations were seen among cohorts. Scapular notching subjects had notably worse outcome scores and significantly less active abduction, forward flexion, and strength, at latest follow-up. Finally, scapular notching cases had markedly more complications, revisions, and humeral radiolucent lines. Hence, in comparison to subjects without scapular notching, scapular notching patients had significantly worse clinical outcomes and less range of motion and these variations crossed the minimal clinically significant difference threshold for several outcome metrics. On the basis of these results, decreasing scapular notching through individual and implant selection and technique modification was suggested.