Purpose <p>Conserving the subscapularis tendon during reverse shoulder arthroplasty (RSA) has proven its impact on postoperative outcomes, particularly regarding stability and range of motion. A subscapularis preserving approach has been developed: the Anterior Muscle Sparing (AMS) approach that enables not to violate the subscapularis tendon. Our aim was to compare this approach with the conventional approach, which consists of reinserting the subscapularis at the end of the procedure, with a specific focus on intraoperative complications and postoperative position of the implants.</p> Methods <p>A retrospective consecutive study was performed of patients undergoing a primary RSA between January 2021 and December 2024 performed by the same surgeon. We included 32 patients receiving the standard approach (SA) and 24 patients receiving the AMS approach. Implant positioning was assessed through three different variables: the glenoid implant inclination relative to the floor of the supraspinatus fossa; the glenoid implant height described as the distance between the inferior border of the glenoid bone surface and the inferior part of the glenoid baseplate; and the humeral stem alignment relative to the intramedullary humeral shaft axis.</p> Results <p>There were no significant differences in terms of glenoid implant inclination (-4.71 ± 6.3° Vs -3.8 ± 7.17°; <i>p</i> = 0.68), glenoid implant height (0.608 ± 1.94&#xa0;mm Vs 0.315 ± 0.896&#xa0;mm ; <i>p</i> = 0.655), and PERFORM^® humeral stem alignment ( 1.34 ± 4.11° Vs 1.89° ± 4.63°; <i>p</i> = 0.715) between the two groups. The intraoperative complication rate was not significant different between the groups, with only two cases within the AMS approach group (<i>p = 0.181</i>). The mean operative times were not significantly different between the groups (94.06&#xa0;min ± 18,71 Vs 81,73&#xa0;min. ±16,58; <i>p</i> = 0,<i>06).</i> Since September 2023, when the senior author started performing RSAs with the described technique only one patient was converted from an AMS to a traditional approach during surgery due to an intraoperative complication.</p> Conclusion <p>When compared to the standard approach, the AMS showed no significant difference in terms of implant positioning, surgical operative times and intraoperative complication rate. An attempt to preserve the subscapularis tendon seems to be always justified, as this method is a safe and reliable alternative to the traditional approach.</p> Level of evidence <p>Level III, Retrospective Cohort Comparison Treatment study.</p>