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

Abstract

Introduction Indications for reverse shoulder arthroplasties (rTSA) have increased since their development by Paul Grammont in 1985. Prosthesis design was enhanced over time, but the management of the tendon of the M. subscapularis (SSC-tendon) in primary rTSA is still a controversial subject with regard to perform a refixation or not. Methods 50 patients were randomized in a refixation group (A) and a non-refixation-group (B) of the SSC-tendon in a double-blinded fashion. SSC-function was assessed at baseline before surgery, such as 3 and 12 months after surgery. Constant–Murley-Shoulder Score (CS), American Shoulder and Elbow Surgeons Score (ASES), strength, range of motion (ROM), and pain on numeric rating scale (NRS) were measured in all examinations. An ultrasound examination of the shoulder was performed for evaluation of subscapularis tendon integrity at 3 and 12 month follow-up visits. Pain was evaluated on NRS via phone 5 days after surgery. Surgery was performed by a single experienced senior surgeon in all patients. Results Patients with a refixation of the SSC-tendon and primary rTSA had improved internal rotation [40° (20°–60°) vs. 32° (20°–45°); p = 0.03] at 12 months of follow-up. Additionally, the A-group had increased CS [74 (13–90) vs. 69.5 (40–79); p = 0.029] 1 year after surgery. Results were strengthened by subgroup analysis of successful refixation in ultrasound examination vs. no refixation. No differences were seen in ASES and NRS 1 year after rTSA. Conclusion SSC-tendon repair in rTSA improves CS and internal rotation 12 months after surgery.

Analysis of three different reverse shoulder arthroplasty designs for cuff tear arthropathy – the combination of lateralization and distalization provides best mobility

“…These studies support our findings that the sum of bipolar lateralization (more rotational movement (humeral lateralization [ 49 ]) and less notching (glenoidal lateralization) [ 30 , 52 ]) and distalization ( more flexion [ 50 ]) with inferior glenosphere overhang ( less notching [ 53 ]) provides best ROM despite no clinically significant difference in outcome scores could be found [ 30 , 46 , 52 , 54 ].…”

“…The same 135° design as that used in our study showed better external rotation and greater abduction strength compared to a 155° design with a tGLO of 18.5 mm at the 1-year follow-up examination [ 49 ].…”

Patient reported outcomes and ranges of motion after reverse total shoulder arthroplasty with and without subscapularis repair

“…In the only randomized trial on the topic, Engel et al studied 50 rTSA patients that were randomized to subscapularis repair vs. non-repair groups and found that repairing the subscapularis resulted in an improved Constant Score and internal rotation 12 months postoperatively. 10 The study however acknowledged a limitation of low sample size of 20 and 21 patients with follow-up in each group and a switch in prosthesis use part way through the study.…”

When should reverse total shoulder arthroplasty be considered in glenohumeral joint arthritis?

“…The clinical significance of subscapularis repair is controversial in RSA. A prospective randomized trial by Engel et al [ 29 ] concluded that subscapularis tendon repair in RSA improves the Constant score and internal rotation at 12 months after surgery. In medialized design RSA, the subscapularis has an important role in preventing dislocation [ 30 ].…”