Irreparable Rotator Cuff Tears Without Arthritis Treated With Reverse Total Shoulder Arthroplasty

Abstract

Background:Irreparable rotator cuff (RC) tears without arthritis is a challenging clinical problem in young adults. Reverse total shoulder arthroplasty (RTSA) has been proposed as one of the surgical treatment options for this condition.Methods:In this review, we discuss the current understanding of the role of RTSA for the management of irreparable RC tears without arthritis based on authors personal experience and available scientific literature.Results:Reverse total shoulder arthroplasty (RTSA) is a constrained arthroplasty system that can allow the deltoid and remaining rotator cuff to substitute for the lost function of irreparable RC. Furthermore, the pain relief is consistent with often a dramatic improvement in patient comfort, shoulder function and stability. In patients with pseudoparalysis of the shoulder without advanced arthritis, RTSA effectively restores forward elevation above the shoulder but may not dramatically improve external (ER) or internal rotation (IR). However, due to concerns over implant longevity, caution has to be exercised when using RTSA for symptomatic irreparable RC tears with preserved active forward elevation (AFE) and in patients less than 65 years of age.Conclusion: RTSA is a reasonable surgical option for irreparable rotator cuff repair without arthritis. However, caution should be exercised when offering RTSA to young patients and patient without pseudoparalysis because they can have a higher complication and dissatisfaction rate. In addition, longevity of RTSA and subsequent need for revision surgery remains a significant concern in this population.

Current concepts in the primary management of irreparable posterosuperior rotator cuff tears without arthritis

“… 32 However, caution should still be exercised when offering RSA to young patients who are often disappointed by the results. 69 , 70 …”

Oncologic reconstruction of the proximal humerus with a reverse total shoulder arthroplasty megaprosthesis

“…Reverse shoulder arthroplasty may provide a more reliable outcome and better functional and pain outcomes . In this semi‐constrained implant, the deltoid muscle is used to provide function in the absence of a rotator cuff . Reverse total shoulder arthroplasty has been used at our institution for patients requiring oncologic resections of the proximal humerus with promising outcomes.…”

Nonarthroplasty Surgical Treatment Options for Massive, Irreparable Rotator Cuff Tears

“…These lesions are characterized by rotator cuff tears >3 cm with advanced fatty infiltration of the rotator cuff tendons, a reduced acromiohumeral interval, significant tendon retraction, and the presence of poor-quality tissue. 36,62 Historically, limited reliable options have existed for the treatment of these tears, and although multiple options have been described, many have been insufficient to meet patients’ demands (eg, isolated arthroscopic debridement), are technically demanding and result in difficult rehabilitation (eg, tendon transfers), and have generally been met with underwhelming clinical success as a whole. One of the recent popular options for MIRCTs has been reverse total shoulder arthroplasty (rTSA), as it allows the deltoid muscle to take over the function of the irreparable rotator cuff muscles and has shown promising clinical results in multiple studies when employed for this indication.…”

“…One of the recent popular options for MIRCTs has been reverse total shoulder arthroplasty (rTSA), as it allows the deltoid muscle to take over the function of the irreparable rotator cuff muscles and has shown promising clinical results in multiple studies when employed for this indication. 23,41,62,63 This technique has become the treatment of choice among surgeons for patients with MIRCTs complicated by significant glenohumeral arthritis, anterosuperior escape, and/or pseudoparalysis. 62 However, complications after rTSA, although improving, have been reported to occur at a rate of 20% to 50% in both the recent and past literature.…”

“…23,41,62,63 This technique has become the treatment of choice among surgeons for patients with MIRCTs complicated by significant glenohumeral arthritis, anterosuperior escape, and/or pseudoparalysis. 62 However, complications after rTSA, although improving, have been reported to occur at a rate of 20% to 50% in both the recent and past literature. 23,41,63 Additionally, there are concerns regarding the longevity of these implants, with a revision rate of 10% to 33% and increasing complication rates with each revision.…”