Effect of glenosphere lateralization with and without coracoacromial ligament transection on acromial and scapular spine strain in reverse shoulder arthroplasty

Haislup, Brett D.; Ashmyan, Roman; Johnston, Peter S.; Wright, Melissa A.; Abbasi, Pooyan; Murthi, Anand M.

doi:10.1016/j.jseint.2022.08.010

Cited by 8 publications

(3 citation statements)

References 20 publications

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“…They found that resecting the CAL redistributes deltoid tensioning strain from the acromion to the SS and decreases maximum principal strain at the acromion compared with that at the SS for all measured abduction angles (p < 0.05), potentially predisposing patients to fractures with a poorer prognosis (Levy II and III). Differing slightly, Haislup et al 61 implanted RSAs in 10 cadaveric shoulders with varying glenosphere lateralization parameters (0, +3, and +6 mm) and measured acromial and SS strain at abduction angles of 30° and 60° before and after cutting the CAL. The authors reported that CAL resection increased acromion strain (845 vs. 580 N, p = 0.049), but decreased SS strain though insignificantly (725 vs. 787 N, p = 0.367).…”

Section: Modifiable Surgical Factorsmentioning

confidence: 99%

“…Resecting all or part of the CAL is occasionally performed for adequate surgical field visualization and to dislocate the shoulder intraoperatively. Biomechanical studies lack consensus regarding whether this practice influences the risk and severity of acromion and SS fractures 61,62 . Taylor et al 62 performed a study on 8 cadaveric shoulders in which an RSA was implanted with a 36-mm standard glenosphere and +3-mm humeral insert and the deltoid was tensioned to create 0°, 30°, and 60° of abduction before and after resecting the CAL.…”

Section: Modifiable Surgical Factorsmentioning

confidence: 99%

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Mitigating Fracture of the Acromion and Scapular Spine After Reverse Shoulder Arthroplasty

Buchanan,

Bindi,

Caban-Klepac

et al. 2023

JBJS Reviews

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» Biomechanical studies report that thin scapular spine (SS) morphology, superiorly placed glenoid components, and increased glenoid baseplate screws contribute to increased acromial and SS strain and may increase fracture risk. » Clinical risk factors of acromial and SS fractures after reverse shoulder arthroplasty include increasing age, female sex, osteoporosis, rheumatoid arthritis, thin midsubstance acromion morphology, previous acromioplasty, and surgical indication of cuff tear arthropathy. » Clinical studies show that, in isolation, excessive humeral lengthening, humeral lateralization, and glenoid medialization may increase risk of acromial and SS fractures. » Biomechanical studies suggest that a combination of glenoid medialization and humeral lateralization (MG/LH) may reduce fracture risk, although this requires clinical correlation. » Surgeons might reduce fracture risk in patients of high-risk groups by guarding against excessively lengthening the humerus, using a MG/LH prosthesis, and targeting screws to avoid the scapular notch and base of the SS. Level of Evidence: Level V. Narrative Review. See Instructions for Authors for a complete description of levels of evidence.

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Section: Modifiable Surgical Factorsmentioning

confidence: 99%

Section: Modifiable Surgical Factorsmentioning

confidence: 99%

Mitigating Fracture of the Acromion and Scapular Spine After Reverse Shoulder Arthroplasty

Buchanan,

Bindi,

Caban-Klepac

et al. 2023

JBJS Reviews

View full text Add to dashboard Cite

show abstract

“…This type of implant adaptation has theoretical advantages, such as increased range of motion (ROM), improved stability, and decreased rate of scapular notching. However, lateralization has also been associated with increased shear forces across the baseplate interface, leading to failure, and increased the stress on the scapula, resulting in acromial stress fractures ( 11 , 12 ). Consequently, the clinical implications of lateralization of the humeral and the glenoid side of rTSA continue to be analyzed both in laboratories and clinically, and long-term outcomes are awaited.…”

Section: Introductionmentioning

confidence: 99%

Narrative review of influence of prosthesis lateralization on clinical outcomes in reverse shoulder arthroplasty: glenoid vs. humerus vs. combined

Łukasiewicz¹,

Harris²,

Bervell³

et al. 2023

Ann Joint

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Background and Objective Reverse shoulder arthroplasty has become a common orthopaedic procedure, with a growing number of cases annually for multiple indications, such as rotator cuff arthropathy, osteoarthritis, or fractures of the proximal humerus, to reduce pain and restore shoulder mobility. Prosthesis design and various recent improvements aim to enhance range of motion (ROM) and stability and to limit component loosening and other potential complications. Many of these well-known issues could theoretically be improved by glenoid, humeral, or combined component lateralization. The objective of this article is to provide an up-to-date literature overview, present available options, and discuss the rationale behind lateralization of certain components, as well as their combined impact on outcomes of reverse shoulder arthroplasty. Methods PubMed and Scopus databases from 2003 to 2023 were searched and screened for studies, including systematic reviews, on the influence of glenoid, humeral, and combined component lateralization that served for narrative review of rationale behind such design. Key Content and Findings Currently, a number of computer simulations, anatomic studies, and limited clinical references aim to support the rationale behind glenoid augmentation, variable humeral neck-shaft angle (NSA), or humeral tray design. Conclusions The utility of lateralization has not yet been clinically established. Randomized, long-term clinical outcome studies are still needed to reach a verdict going beyond surgeon preference and case-specific indications.

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Effect of reverse shoulder arthroplasty humeral component retroversion on acromial strain

O’Leary

Haislup

Gillin

et al. 2023

Journal of Shoulder and Elbow Surgery

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Effect of glenosphere lateralization with and without coracoacromial ligament transection on acromial and scapular spine strain in reverse shoulder arthroplasty

Cited by 8 publications

References 20 publications

Mitigating Fracture of the Acromion and Scapular Spine After Reverse Shoulder Arthroplasty

Mitigating Fracture of the Acromion and Scapular Spine After Reverse Shoulder Arthroplasty

Narrative review of influence of prosthesis lateralization on clinical outcomes in reverse shoulder arthroplasty: glenoid vs. humerus vs. combined

Effect of reverse shoulder arthroplasty humeral component retroversion on acromial strain

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