Restoration of External Rotation Following Reverse Shoulder Arthroplasty without Latissimus Dorsi Transfer

Abstract

Background:Latissimus dorsi transfers have been considered necessary to restore active external rotation following reverse shoulder arthroplasty (RSA). The purpose of this study was to assess the effectiveness of an RSA system that lateralizes the center of rotation in restoring active external rotation without a latissimus dorsi transfer in patients with a preoperative external rotation deficit (external rotation of <0°).Methods:We retrospectively reviewed the records of patients who had undergone RSA with a lateralized center of rotation without a latissimus dorsi transfer. All patients had had a preoperative external rotation deficit (active external rotation of <0°), and all were followed for a minimum of 2 years. Patients were stratified into 2 groups on the basis of the preoperative diagnosis: (1) those with a combined loss of active elevation and external rotation as a result of rotator cuff tear arthropathy (CLEER group) and (2) those with a combined loss of active elevation and external rotation as a result of other posttraumatic etiologies (non-CLEER group). The mean improvement of external rotation was analyzed. Subgroup analysis was performed on the basis of the Goutallier classification, glenosphere lateralization, and total prosthetic lateralization.Results:Thirty-three patients (24 in the CLEER group and 9 in the non-CLEER group) met the inclusion criteria. The average follow-up was 43.4 months (range, 24 to 77 months). External rotation improved significantly in both the CLEER group (from −21° preoperatively to 28° postoperatively; p < 0.001) and the non-CLEER group (from −19° preoperatively to 26° postoperatively; p = 0.001). Goutallier classification, glenosphere lateralization, and total prosthetic lateralization were not correlated with the degree of improvement of external rotation in either group (p > 0.05 for all).Conclusions:RSA with a lateralized center of rotation can effectively restore external rotation without the use of a latissimus dorsi transfer in patients with a preoperative external rotation deficit as a result of rotator cuff arthropathy or other posttraumatic etiologies.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Reverse Shoulder Prosthesis With a Lateralized Glenosphere: Early Results of a Prospective Multicenter Study Stratified by Diagnosis

“…1,15,17 Improvements in aER were also observed in this study, and this has been related to the lateralized glenosphere design. 24,25 The ΔER of 17° observed for patients with cuff tear arthropathy is comparable 1,7 to that reported by the design team, but it is greater than that reported in early studies of Grammont-type prostheses employing a medialized glenosphere. 14,17 Moreover, the ΔER for patients with less than 0° aER preoperatively was 42°.…”

How to Optimize Reverse Shoulder Arthroplasty for Irreparable Cuff Tears

“…A second category of patients that may not be as satisfied after RSA are those with isolated loss of active external rotation [9]. Even though improved external rotation has been reported after RSA in patients with an intact teres minor, especially with use of implants that provide a larger lateral offset [10], patients with preserved active elevation but pseudoparalysis in external rotation are better candidates for a tendon transfer. In our practice, a lower trapezius transfer is preferred to a latissimus dorsi transfer to restore active external rotation in shoulders of patients with isolated loss of active external rotation [11].…”

Reverse shoulder arthroplasty with and without latissimus and teres major transfer for patients with combined loss of elevation and external rotation: a prospective, randomized investigation

“…4 To address the persistent active external rotation deficit, Boileau et al 6 developed a surgical technique that combines RSA with a modified latissimus dorsi (LD) and teres major (TM) tendon transfer. The rationale behind the technique is 2-fold: (1) The RSA will address the shoulder imbalance in the vertical plane by providing a fixed center of rotation and optimizing the mechanical advantage of the deltoid for active elevation, and (2) the tendon transfer will address the horizontal imbalance by transferring 2 of the 4 internal rotators to positions that allow for active external rotation. 6 Boileau et al 6 published their results in a prospective case series.…”