Subscapularis Repair Is Unnecessary After Lateralized Reverse Shoulder Arthroplasty

Roberson, Troy A.; Shanley, Ellen; Griscom, James T.; Granade, Michael; Hunt, Quinn; Adams, Kyle; Momaya, Amit; Kwapisz, Adam; Kissenberth, Michael J.; Lonergan, Keith T.; Tolan, Stefan J.; Hawkins, Richard J.; Tokish, John M.

doi:10.2106/jbjs.oa.17.00056

Cited by 23 publications

(20 citation statements)

References 35 publications

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“… 38 Additionally although some reports have found absence of subscapularis repair being significantly associated with prosthetic instability, 40 others found no difference between repair vs. no repair, 261 and using a lateralized RSA subscapularis repair may not be necessary. 207 …”

Section: Discussionmentioning

confidence: 99%

The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

Shah

Roche²,

Sullivan³

et al. 2021

JSES International

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Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous. Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests. Results The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; P < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; P = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%. Conclusions Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.

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Section: Discussionmentioning

confidence: 99%

The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

Shah

Roche²,

Sullivan³

et al. 2021

JSES International

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“…In contrast, Roberson et al 20 found no functional outcome, range of motion, or complication differences in 99 patients with and without subscapularis repair using lateralized glenoid prostheses. However, in the subscapularis repair subset, patients who underwent a subscapularis peel and repair had better change in forward elevation (26° more) compared with the tenotomy and repair group, but had similar American Shoulder and Elbow Surgeons and Penn Shoulder scores 20 . Friedman et al 7 reported on 591 primary RSA patients comparing functional outcomes with and without subscapularis repair using a lateralized humeral implant showing no difference in range of motion or outcomes scores between the groups.…”

Section: Discussionmentioning

confidence: 92%

“…One study found that RSA with glenosphere lateralization (+3 or +6 mm) had worse improvements in American Shoulder and Elbow Surgeons scores if the subscapularis tendon was repaired 25 . In contrast, Roberson et al 20 found no functional outcome, range of motion, or complication differences in 99 patients with and without subscapularis repair using lateralized glenoid prostheses. However, in the subscapularis repair subset, patients who underwent a subscapularis peel and repair had better change in forward elevation (26° more) compared with the tenotomy and repair group, but had similar American Shoulder and Elbow Surgeons and Penn Shoulder scores 20 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite this apparent biomechanical disadvantage, some surgeons recommend subscapularis repair to reduce instability rates 2 , 3 and improve internal rotation 7 , 14 . Other surgeons have shown similar dislocation rates with and without subscapularis repair in RSA 4 , 7 , 20 , 23 , 25 . A recent meta-analysis reported that subscapularis repair when using a medialized RSA design may be prudent to decrease the risk of dislocation, 15 which is attributed to the deltoid imparting a lateral force to the humerus in the medialized RSA design.…”

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confidence: 99%

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The over-the-top subscapularis repair in reverse shoulder arthroplasty: biomechanical evaluation of a novel technique

et al. 2019

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BackgroundWe evaluate the effect of repairing the upper subscapularis tendon at an alternative location on the anterior greater tuberosity above the center of rotation using a reverse shoulder arthroplasty (RSA) muscle model.MethodsWe compared an innovative subscapularis repair on the anterior aspect of the greater tuberosity with the standard repair on the lesser tuberosity in a previously validated digital linear RSA muscle model. Standard repair vs. a new repair datasets were compared for 3 RSA designs. Each model was run through humeral abduction from 0° to 140° in 2.5° increments; the resulting moment arm measurements (model of tendon efficiency) were recorded in millimeters for 3 sections (superior, middle, inferior). An isolated upper two-thirds subscapularis repair to the anterior greater tuberosity was also evaluated (the over-the-top repair).ResultsThe new over-the-top subscapularis repair significantly increased the abduction moment arm lengths in the superior, middle, and inferior subscapularis components compared with the standard repair to the lesser tuberosity at all levels of glenohumeral abduction and for all 3 RSA designs. Repair of the upper two-thirds of the subscapularis to the new location was an abductor at a much lower level of abduction compared with the native subscapularis repair.ConclusionBy repairing the upper subscapularis tendon above the center of rotation (over-the-top repair) in an RSA muscle model, the subscapularis has an improved movement arm and functions as an abductor through a greater range of motion that may result in clinically increased muscle efficiency and improved strength.

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“…Biomechanical studies have evaluated COR, humeral neck-shaft angle, humeral offset, humeral version, glenosphere diameter, superior-inferior glenosphere positioning, implant tilt, as well as soft tissue repair of the rotator cuff. 1 , 8 , 16 , 18 , 19 , 20 , 21 , 30 , 34 , 35 All these factors must be considered when evaluating implant design and implantation techniques.…”

Section: Discussionmentioning

confidence: 99%

Infraspinatus or teres minor fatty infiltration does not influence patient outcomes after reverse shoulder arthroplasty with a lateralized glenoid

Kwapisz¹,

Rogers²,

Thigpen³

et al. 2021

JSES International

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Background Previous studies show that reverse shoulder arthroplasty (RSA) may improve forward elevation (FE) but external rotation may remain impaired with substantial teres minor fatty infiltration. The purpose of this study was to examine the influence of fatty infiltration on postoperative range of motion (ROM) and patient-reported outcomes (PROs) after RSA with a more lateralized center of rotation. Methods About 69 patients (average age 69 years; 44 women, 25 men) with preoperative MRI, 1-year postoperative ROM, 2-year Veteran’s Rand Survey, American Shoulder and Elbow Surgeons subjective form, and Single Alpha-Numeric Evaluation scores who underwent RSA with a lateralized glenoid component between 2010 and 2014 were identified. Patients with Fuchs stage 3 fatty degeneration were compared with patients with Fuchs stage ≤ 2 using a one-way ANOVA. Results Eleven patients had Fuchs stage 3 in the teres minor and 28 with stage 3 in the infraspinatus. Charlson comorbidity indices, Veteran’s Rand Survey scores, age, and BMI were not different between groups. There were no differences after one year (follow-up = 15 ± 14 months) in FE (FE = 128 ± 29) or external rotation (33 ± 13) between groups. There were no differences in two-year minimum (follow-up = 42.9 ± 17.9 months) American Shoulder and Elbow Surgeons scores between degenerated teres minor (76.4 ± 20) or infraspinatus (69.1 ± 24) groups. Conclusion This is the first study to assess the influence of teres minor and infraspinatus fatty infiltration on the postoperative ROM and PROs with a more lateralized glenoid RSA implant. Our results show that in a more lateralized RSA, neither teres minor nor infraspinatus fatty infiltration appear to negatively influence ROM or PROs.

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Subscapularis Repair Is Unnecessary After Lateralized Reverse Shoulder Arthroplasty

Cited by 23 publications

References 35 publications

The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

The over-the-top subscapularis repair in reverse shoulder arthroplasty: biomechanical evaluation of a novel technique

Infraspinatus or teres minor fatty infiltration does not influence patient outcomes after reverse shoulder arthroplasty with a lateralized glenoid

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