Subscapularis in Reverse Total Shoulder Arthroplasty

Bigdon, Sebastian F.; Bolliger, Lilianna; Albers, Christoph E.

doi:10.1177/2471549219834192

Cited by 10 publications

(2 citation statements)

References 43 publications

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“…For example, several studies have reported equivalent outcomes in IR with or without repair of the subscapularis. 3,6 In a subscapularissacrificing approach, one would suspect a difference in IR given that the primary tendon involved in IR is no longer functional. However, this study demonstrates that depending on the method of measuring outcome, such as PROMs as opposed to the ability to internal rotate with a smooth unassisted motion, there in fact may be a difference, which was not detected.…”

Section: Discussionmentioning

confidence: 99%

Comparing patient-reported outcome measures and physical examination for internal rotation in patients undergoing reverse shoulder arthroplasty: does surgery alter patients' perception of function?

Southard

Ode

Simon

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: The purpose of this study was to evaluate how patients treated with reverse shoulder arthroplasty (RSA) achieve internal rotation (IR) using video assessment and to compare this to patient-reported outcome measures (PROMs). Methods: We reviewed 215 preoperative and 657 postoperative videos (3-78 months) for 215 patients who underwent primary RSA, performing IR using the modified vertebral level method. Their functional motion pattern was then grouped into 3 types: type I, could not reach behind their back; type II, able to reach to at least waist level, with assistance; and type III, able to reach to a minimum of waist level in an uninterrupted fashion. Patients completed functional questions (put on a coat, wash back, tuck in a shirt, and manage toileting) and a diagram of perceived IR. Patients' functional motion types were compared to PROM answers. Pre-and postoperative scores were also compared to assess the effect of surgery on patients' perception of IR function. Results: Patients undergoing RSA will achieve IR in 3 distinct motion patterns. Analysis of self-reported IR indicated statistically significant difference between the 3 functional types of IR (P < .001). Patient-perceived IR was not significantly different between the 3 studied IR functional types (P ¼ .076) in the analysis of preoperative measures but was significantly different in the postoperative setting (P < .001). Conclusion: Patients attempt IR in 3 distinct functional motion patterns. The improvement of IR after RSA is measured better by patient questionnaires than by physical examination.This study was determined to be exempt from review by the Western Institutional Review Board (WIRB).

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Section: Discussionmentioning

confidence: 99%

Comparing patient-reported outcome measures and physical examination for internal rotation in patients undergoing reverse shoulder arthroplasty: does surgery alter patients' perception of function?

Southard

Ode

Simon

et al. 2021

Journal of Shoulder and Elbow Surgery

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“…However, clinical studies demonstrating a superior axial ROM for lateralized versus Grammont-style RSA are rare because they require surgeons to implant prostheses of varying designs. Furthermore, successful repair of the subscapularis is believed by many surgeons to influence postoperative ROM, although clinical evidence is variable [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Influence of lateralized versus medialized reverse shoulder arthroplasty design on external and internal rotation: a systematic review and meta-analysis

Hao,

Cueto,

Gharby

et al. 2024

Clin Shoulder Elb

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Background: Restoration of external (ER) and internal rotation (IR) after Grammont-style reverse shoulder arthroplasty (RSA) is often unreliable. The purpose of this systematic review was to evaluate the influence of RSA medio-lateral offset and subscapularis repair on axial rotation after RSA. Methods: We conducted a systematic review of studies evaluating axial rotation (ER, IR, or both) after RSA with a defined implant design. Medio-lateral implant classification was adopted from Werthel et al. Demographics and outcomes were reported as weighted means and pooled proportions. Meta-analysis was conducted using a random-effects model.Results: Thirty-two studies reporting 2,233 RSAs were included (mean patient age, 72.5 years; follow-up, 43 months; 64% female). The subscapularis was repaired in 91% (n=2,032) of shoulders and did not differ based on global implant lateralization (91% for both, P=0.602). On meta-analysis, globally lateralized implants achieved greater postoperative ER (40° [36°–44°] vs. 27° [22°–32°], P<0.001) and postoperative improvement in ER (20° [15°–26°] vs. 10° [5°–15°], P<0.001). Lateralized implants with subscapularis repair or medialized implants without subscapularis repair had significantly greater postoperative ER and postoperative improvement in ER compared to globally medialized implants with subscapularis repair (P<0.001 for both). Mean postoperative IR was reported in 56% (n=18) of studies and achieved the minimum necessary IR in 51% of lateralized (n=325, 6 studies) versus 36% (n=177, 4 studies) of medialized implants.Conclusions: Lateralized RSA produces superior axial rotation compared to medialized RSA. Lateralized RSA with subscapularis repair and medialized RSA without subscapularis repair provide greater axial rotation compared to medialized RSA with subscapularis repair.Level of Evidence: 2A.

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