Is subscapularis repair correlated with better outcome compared to non-repair in reverse total shoulder arthroplasty? A systematic review of comparative trials

Abstract

We aimed to investigate whether combined reverse total shoulder arthroplasty (RTSA) and subscapularis repair leads to improved clinical and functional outcome in comparison with RTSA alone. Two reviewers independently conducted a systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms “reverse” AND “shoulder” AND “arthroplasty” AND “with” AND “subscapularis” AND “repair”. From the 72 initial studies, we finally chose five studies which were eligible to our inclusion-exclusion criteria. The total mean modified Coleman methodology test was 55/100 (range: 47/100 to 60/100). The eligible studies included 1087 patients, in total. Regarding the subjective functional scores as well as range of motion (ROM), the differences amongst groups were insignificant in almost all studies. The mean complications’ rate of the repair group was 10.4%, whereas the respective rate of the non-repair group was 10.2%. All studies concluded that the repair of subscapularis did not affect the complications’ rate of patients who were treated with RTSA. The mean dislocations’ rates of the repair and the non-repair group were 1.5% and 2.3%, respectively. Although subscapularis repair was proven safe and effective for the augmentation of RTSA, it did not offer any additional clinical or functional benefit in the outcome of patients treated with lateralized RTSA. Therefore, it is not supported its routine use for patients who have a preoperatively sufficient subscapularis tendon.

Results after primary reverse shoulder arthroplasty with and without subscapularis repair: a prospective-randomized trial

“…Only retrospective or non-randomized studies existed prior to our study [6,10,11,13,14,23,24]. Malahias et al [23] did a review of the most common (retrospective) studies on this question [6,10,11,13,14], focusing on functional outcomes and dislocation rates after rTSA. They concluded that a…”

“…To our knowledge, this is the first prospective-randomized trial analyzing the management of the SSC-tendon in primary rTSA. Only retrospective or non-randomized studies existed prior to our study [ 6 , 10 , 11 , 13 , 14 , 23 , 24 ]. Malahias et al [ 23 ] did a review of the most common (retrospective) studies on this question [ 6 , 10 , 11 , 13 , 14 ], focusing on functional outcomes and dislocation rates after rTSA.…”

“…Only retrospective or non-randomized studies existed prior to our study [ 6 , 10 , 11 , 13 , 14 , 23 , 24 ]. Malahias et al [ 23 ] did a review of the most common (retrospective) studies on this question [ 6 , 10 , 11 , 13 , 14 ], focusing on functional outcomes and dislocation rates after rTSA. They concluded that a reattachment of the SSC-tendon does not lead to a clinical benefit as only Friedmann et al [ 10 ] could show increased CS and internal rotation in the refixation group.…”

Shoulder strength outcomes after reverse total shoulder arthroplasty: a systematic review and descriptive synthesis

“…Reverse total shoulder arthroplasty (rTSA) is a surgical technique that was approved for use in the United States in the early 2000's 15 . The prosthetic design compensates rotator cuff deficiency through medialization of the glenohumeral region such that the deltoid functions to both elevate and abduct the glenohumeral joint 12 . While the prosthesis utility has expanded to address a various glenohumeral bony pathologies and cases of severe chronic instability 5 , management of the subscapularis tendon during rTSA remains a topic of debate.…”

A pilot-study focusing on internal rotation after reverse total shoulder arthroplasty using the Activities of Daily Living which require Internal Rotation (ADLIR) score

“…17,18 The subscapularis tendon Biomechanic and functional implications of subscapularis tendon repair have been investigated thoroughly in patients treated with reverse total shoulder arthroplasty. [18][19][20] Whether to repair the subscapularis tendon or not remains an interesting topic in the field of reverse total shoulder arthroplasty. Friedman et al reported excellent outcomes after RTSA for both patients with and without subscapularis repair with a follow-up comparable to this present study.…”