How to Optimize Reverse Shoulder Arthroplasty for Irreparable Cuff Tears

Abstract

Purpose of the Review Reverse shoulder arthroplasty (RSA) is commonly considered as one of the options for surgical management of the functionally irreparable rotator cuff tear (FIRCT). This article reviews tips and tricks to optimize the outcome of RSA when performed specifically for this indication. Recent Findings RSA has been reported to provide satisfactory outcomes in a large proportion of patients with FIRCTs. However, subjective satisfaction is lesser in patients with well-maintained preoperative motion as well as those with isolated loss of active external rotation. The popularity of implants that provide some degree of global lateralization continues to increase. Optimizing the outcome of RSA for FIRCTs requires a careful balance between minimizing perimeter impingement and enhancing the function of intact muscles, in particular the deltoid and any remaining rotator cuff. Controversy continues regarding the benefits and disadvantages of subscapularis repair at the time of RSA. Tendon and muscle transfers performed at the time of RSA have the potential to optimize the outcome in selected patients with profound weakness in external rotation or those with severe deltoid dysfunction. Summary When RSA is considered for patients with a FIRCT without arthritis, careful attention to indications and technical pearls may contribute to optimize outcomes.

Outcome Comparison of Latissimus Dorsi Transfer and Pectoralis Major Transfer for Irreparable Subscapularis Tendon Tear: A Systematic Review

“…9,67 Currently, salvage options for ISScT include anterior capsule reconstruction, 36,62 tendon transfer, 5,34 and reverse shoulder arthroplasty. 10,64 In recent cadaveric studies, anterior capsule reconstruction has been developed for treating ISScT with the theoretical feasibility to restore the anteroinferior shoulder stability but with decreased range of motion (ROM) as a result. 36,54,62 Reverse shoulder arthroplasty has been proposed for older patients with shoulder instability and osteoarthritis 17,20 but it is not recommended for active or young patients without severe arthrosis.…”

Bipolar lateralization in reverse shoulder arthroplasty for avoidance of scapular notching

“…Several studies have been published to showthatlateralizedhumeralandglenoid components have lower rates of radiographic scapular notching compared to medialized implants [3,11]. However, data on bipolar lateralization are limited.…”

Current Concepts in Humeral Component Design for Anatomic and Reverse Shoulder Arthroplasty

“…In the field of reverse shoulder arthroplasty, preoperative planning software reveals that using a larger glenoid with a larger lateral offset and an inferior overhang is the most successful strategy to optimize the range of motion free of impingement, especially when combined with a more vertical (typically 135 degree) polyethylene opening angle [ 22 ].…”

“…Understanding the nuances associated with the design and implantation of the humeral component in reverse shoulder arthroplasty is not possible without considering the glenoid side [ 22 ]. Currently, most would agree that reverse shoulder arthroplasty requires a fine balance between (1) maximizing impingement-free range of motion and (2) optimizing soft tissue tension and muscle function around the shoulder.…”