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How to Optimize Reverse Shoulder Arthroplasty for Irreparable Cuff Tears

  • Surgical Management of Massive Irreparable Cuff Tears (J Sanchez-Sotelo, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

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.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. •• Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993;16(1):65–8 This is one of the first publications by Dr. Grammont introducing for the first time the revolutionary concepts of modern reverse shoulder arthroplasty.

    Article  CAS  Google Scholar 

  2. Kennon, J.C., Songy C., Bartels D., Statz J., Cofield R.H., Sperling J.W., Sanchez-Sotelo J., Primary reverse shoulder arthroplasty: how did medialized and glenoid-based lateralized style prostheses compare at 10 years? J Shoulder Elb Surg, 2020.

  3. Mulieri P, Dunning P, Klein S, Pupello D, Frankle M. Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. J Bone Joint Surg Am. 2010;92(15):2544–56.

    Article  Google Scholar 

  4. •• Hartzler RU, et al. Reverse shoulder arthroplasty for massive rotator cuff tear: risk factors for poor functional improvement. J Shoulder Elbow Surg. 2015;24(11):1698–706 This manuscript analyzes in deepth which patients benefit the least from reverse shoulder arthroplasty in the setting of a functionally irreparable rotator cuff tear.

    Article  Google Scholar 

  5. Barco R, Savvidou OD, Sperling JW, Sanchez-Sotelo J, Cofield RH. Complications in reverse shoulder arthroplasty. EFORT Open Rev. 2016;1(3):72–80.

    Article  Google Scholar 

  6. •• Werthel JD, et al. Lateralization in reverse shoulder arthroplasty: a descriptive analysis of different implants in current practice. Int Orthop. 2019;43(10):2349–60 This publication demonstrate the wide range of humeral lateralization provided by the various implants currently available to perform reverse shoulder arthroplasty.

    Article  Google Scholar 

  7. Burnier M, Elhassan BT, Sanchez-Sotelo J. Surgical management of irreparable rotator cuff tears: what works, what does not, and what is coming. J Bone Joint Surg Am. 2019;101(17):1603–12.

    Article  Google Scholar 

  8. Gilbart MK, Gerber C. Comparison of the subjective shoulder value and the constant score. J Shoulder Elb Surg. 2007;16(6):717–21.

    Article  Google Scholar 

  9. Boileau P, Baba M, McClelland WB Jr, Thélu CÉ, Trojani C, Bronsard N. Isolated loss of active external rotation: a distinct entity and results of L'Episcopo tendon transfer. J Shoulder Elb Surg. 2018;27(3):499–509.

    Article  Google Scholar 

  10. Berglund DD, Rosas S, Triplet JJ, Kurowicki J, Horn B, Levy JC. Restoration of external rotation following reverse shoulder arthroplasty without latissimus dorsi transfer. JB JS Open Access. 2018;3(2):e0054.

    Article  Google Scholar 

  11. Elhassan BT, Alentorn-Geli E, Assenmacher AT, Wagner ER. Arthroscopic-assisted lower trapezius tendon transfer for massive irreparable posterior-superior rotator cuff tears: surgical technique. Arthrosc Tech. 2016;5(5):e981–8.

    Article  Google Scholar 

  12. Elhassan BT, Wagner ER, Werthel JD, Lehanneur M, Lee J. Outcome of reverse shoulder arthroplasty with pedicled pectoralis transfer in patients with deltoid paralysis. J Shoulder Elb Surg. 2018;27(1):96–103.

    Article  Google Scholar 

  13. Salazar DH, Chalmers PN, Mackinnon SE, Keener JD. Reverse shoulder arthroplasty after radial-to-axillary nerve transfer for axillary nerve palsy with concomitant irreparable rotator cuff tear. J Shoulder Elb Surg. 2017;26(1):e23–8.

    Article  Google Scholar 

  14. Friedman RJ, Barcel DA, Eichinger JK. Scapular notching in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2019;27(6):200–9.

    Article  Google Scholar 

  15. Lévigne C, Boileau P, Favard L, Garaud P, Molé D, Sirveaux F, et al. Scapular notching in reverse shoulder arthroplasty. J Shoulder Elb Surg. 2008;17(6):925–35.

    Article  Google Scholar 

  16. Duethman NC, Aibinder WR, Nguyen NTV, Sanchez-Sotelo J. The influence of glenoid component position on scapular notching: a detailed radiographic analysis at midterm follow-up. JSES Int. 2020;4(1):144–50.

    Article  Google Scholar 

  17. Lieber RL, Roberts TJ, Blemker SS, Lee SSM, Herzog W. Skeletal muscle mechanics, energetics and plasticity. J Neuroeng Rehabil. 2017;14(1):108.

    Article  Google Scholar 

  18. Hamilton MA, Diep P, Roche C, Flurin PH, Wright TW, Zuckerman JD, et al. Effect of reverse shoulder design philosophy on muscle moment arms. J Orthop Res. 2015;33(4):605–13.

    Article  Google Scholar 

  19. Lädermann A, Chiu JCH, Cunningham G, Hervé A, Piotton S, Bothorel H, et al. Do short stems influence the cervico-diaphyseal angle and the medullary filling after reverse shoulder arthroplasties? Orthop Traumatol Surg Res. 2020;106(2):241–6.

    Article  Google Scholar 

  20. Iannotti JP, Walker K, Rodriguez E, Patterson TE, Jun BJ, Ricchetti ET. Accuracy of 3-dimensional planning, implant templating, and patient-specific instrumentation in anatomic total shoulder arthroplasty. J Bone Joint Surg Am. 2019;101(5):446–57.

    Article  Google Scholar 

  21. Boileau P, Moineau G, Roussanne Y, O’Shea K. Bony increased offset-reversed shoulder arthroplasty (BIO-RSA). JBJS Essent Surg Tech. 2017;7(4):e37.

    Article  Google Scholar 

  22. Iannotti JP, McCarron J, Raymond CJ, Ricchetti ET, Abboud JA, Brems JJ, et al. Agreement study of radiographic classification of rotator cuff tear arthropathy. J Shoulder Elb Surg. 2010;19(8):1243–9.

    Article  Google Scholar 

  23. Friedman RJ, Hawthorne KB, Genez BM. The use of computerized tomography in the measurement of glenoid version. J Bone Joint Surg Am. 1992;74(7):1032–7.

    Article  CAS  Google Scholar 

  24. Boileau P, Gauci MO, Wagner ER, Clowez G, Chaoui J, Chelli M, et al. The reverse shoulder arthroplasty angle: a new measurement of glenoid inclination for reverse shoulder arthroplasty. J Shoulder Elb Surg. 2019;28(7):1281–90.

    Article  Google Scholar 

  25. •• Gutiérrez S, et al. Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors. J Bone Joint Surg Am. 2008;90(12):2606–15 This is a detailed biomechanical analysis of the multiple factors that influence perimeter impingement and how to undestand their hierarchy.

    Article  Google Scholar 

  26. Matthewson G, Kooner S, Kwapisz A, Leiter J, Old J, MacDonald P. The effect of subscapularis repair on dislocation rates in reverse shoulder arthroplasty: a meta-analysis and systematic review. J Shoulder Elb Surg. 2019;28(5):989–97.

    Article  Google Scholar 

  27. Rol M, Favard L, Berhouet J. Factors associated with internal rotation outcomes after reverse shoulder arthroplasty. Orthop Traumatol Surg Res. 2019;105(8):1515–9.

    Article  Google Scholar 

  28. Dedy NJ, Gouk CJ, Taylor FJ, Thomas M, Tan SLE. Sonographic assessment of the subscapularis after reverse shoulder arthroplasty: impact of tendon integrity on shoulder function. J Shoulder Elb Surg. 2018;27(6):1051–6.

    Article  Google Scholar 

  29. Giles JW, Langohr GDG, Johnson JA, Athwal GS. The rotator cuff muscles are antagonists after reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2016;25(10):1592–600.

    Article  Google Scholar 

  30. Puskas GJ, Catanzaro S, Gerber C. Clinical outcome of reverse total shoulder arthroplasty combined with latissimus dorsi transfer for the treatment of chronic combined pseudoparesis of elevation and external rotation of the shoulder. J Shoulder Elb Surg. 2014;23(1):49–57.

    Article  Google Scholar 

  31. •• Boileau P, et al. Modified latissimus dorsi and teres major transfer through a single delto-pectoral approach for external rotation deficit of the shoulder: as an isolated procedure or with a reverse arthroplasty. J Shoulder Elbow Surg. 2007;16(6):671–82 This is one of the seminal articles that popularized the concept of transfer of the latissimus dorsi performed through a deltopectoral approach to restore active external rotation.

    Article  Google Scholar 

  32. Kirsch JM, Namdari S. Rehabilitation after anatomic and reverse total shoulder arthroplasty: a critical analysis review. JBJS Rev. 2020;8(2):e0129.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Joaquin Sanchez-Sotelo

  2. Roth McFarlane Centre, London, ON, Canada

    George S. Athwal

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  1. Joaquin Sanchez-Sotelo
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Corresponding author

Correspondence to Joaquin Sanchez-Sotelo.

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Conflict of Interest

Dr. Joaquin Sanchez-Sotelo, MD PhD, receives royalties from Stryker, consulting fees from Exactech and Wright Medical, publication royalties from Elsevier and Oxford University Press, and an honorarium from Journal of Shoulder and Elbow Surgery.

Dr. George S. Athwall MD receives royalties from Conmed and consulting fees from Exactech and Wright Medical.

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This article is part of the Topical Collection on Surgical Management of Massive Irreparable Cuff Tears

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Sanchez-Sotelo, J., Athwal, G.S. How to Optimize Reverse Shoulder Arthroplasty for Irreparable Cuff Tears. Curr Rev Musculoskelet Med 13, 553–560 (2020). https://doi.org/10.1007/s12178-020-09655-7

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  • DOI: https://doi.org/10.1007/s12178-020-09655-7

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