Clinical Orthopaedics and Related Research®

, Volume 471, Issue 3, pp 940–946 | Cite as

Lateralized Reverse Shoulder Arthroplasty Maintains Rotational Function of the Remaining Rotator Cuff

  • Stefan Greiner
  • Christan Schmidt
  • Christian König
  • Carsten Perka
  • Sebastian Herrmann
Basic Research



Humeral rotation often remains compromised after nonlateralized reverse shoulder arthroplasty (RSA). Reduced rotational moment arms and muscle slackening have been identified as possible reasons for this impairment. Although several clinical studies suggest lateralized RSA may increase rotation, it is unclear whether this is attributable to preservation of rotational moment arms and muscle pretension of the remaining rotator cuff.


The lateralized RSA was analyzed to determine whether (1) the rotational moment arms and (2) the origin-to-insertion distances of the teres minor and subscapularis can be preserved, and (3) their flexion and abduction moment arms are decreased.


Lateralized RSA using an 8-mm resin block under the glenosphere was performed on seven cadaveric shoulder specimens. Preimplantation and postimplantation CT scans were obtained to create three-dimensional shoulder surface models. Using these models, function-specific moment arms and origin-to-insertion distances of three segments of the subscapularis and teres minor muscles were calculated.


The rotational moment arms remained unchanged for the middle and caudal subscapularis and teres minor segments in all tested positions (subscapularis, −16.1 mm versus −15.8 mm; teres minor, 15.9 mm versus 15.3 mm). The origin-to-insertion distances increased or remained unchanged in any muscle segment apart from the distal subscapularis segment at 0° abduction (139 mm versus 145 mm). The subscapularis and teres minor had increased flexion moment arms in abduction angles smaller than 60° (subscapularis, 2.7 mm versus 8.3 mm; teres minor, −6.6 mm versus 0.8 mm). Abduction moment arms decreased for all segments (subscapularis, 4 mm versus −11 mm; teres minor, −3.6 mm versus −19 mm).


After lateralized RSA, the subscapularis and teres minor maintained their length and rotational moment arms, their flexion forces were increased, and abduction capability decreased.

Clinical Relevance

Our findings could explain clinically improved rotation in lateralized RSA in comparison to nonlateralized RSA.

Supplementary material

11999_2012_2692_MOESM1_ESM.docx (24 kb)
Supplementary material 1 (DOCX 25 kb)


  1. 1.
    Boileau P, Chuinard C, Roussanne Y, Bicknell RT, Rochet N, Trojani C. Reverse shoulder arthroplasty combined with a modified latissimus dorsi and teres major tendon transfer for shoulder pseudoparalysis associated with dropping arm. Clin Orthop Relat Res. 2008;466:584–593.PubMedCrossRefGoogle Scholar
  2. 2.
    Boileau P, Chuinard C, Roussanne Y, Neyton L, Trojani C. 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;16:671–682.PubMedCrossRefGoogle Scholar
  3. 3.
    Boileau P, Moineau G, Roussanne Y, O’Shea K. Bony Increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation. Clin Orthop Relat Res. 2011;469:2558–2567.PubMedCrossRefGoogle Scholar
  4. 4.
    Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg. 2006;15:527–540.PubMedCrossRefGoogle Scholar
  5. 5.
    Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg. 2005;14(1 suppl):147S–161S.PubMedCrossRefGoogle Scholar
  6. 6.
    Boulahia A, Edwards TB, Walch G, Baratta RV. Early results of a reverse design prosthesis in the treatment of arthritis of the shoulder in elderly patients with a large rotator cuff tear. Orthopedics. 2002;25:129–133.PubMedGoogle Scholar
  7. 7.
    Clark JC, Ritchie J, Song FS, Kissenberth MJ, Tolan SJ, Hart ND, Hawkins RJ. Complication rates, dislocation, pain, and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis. J Shoulder Elbow Surg. 2012;21:36–41.PubMedCrossRefGoogle Scholar
  8. 8.
    Coughlin MJ, Morris JM, West WF. The semiconstrained total shoulder arthroplasty. J Bone Joint Surg Am. 1979;61:574–581.PubMedGoogle Scholar
  9. 9.
    Cuff D, Pupello D, Virani N, Levy J, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am. 2008;90:1244–1251.PubMedCrossRefGoogle Scholar
  10. 10.
    Favard L, Levigne C, Nerot C, Gerber C, De Wilde L, Mole D. Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time? Clin Orthop Relat Res. 2011;469:2469–2475.PubMedCrossRefGoogle Scholar
  11. 11.
    Favre P, Sheikh R, Fucentese SF, Jacob HA. An algorithm for estimation of shoulder muscle forces for clinical use. Clin Biomech (Bristol, Avon). 2005;20:822–833.CrossRefGoogle Scholar
  12. 12.
    Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency: a minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 2005;87:1697–1705.PubMedCrossRefGoogle Scholar
  13. 13.
    Gatti CJ, Dickerson CR, Chadwick EK, Mell AG, Hughes RE. Comparison of model-predicted and measured moment arms for the rotator cuff muscles. Clin Biomech (Bristol, Avon). 2007;22:639–644.CrossRefGoogle Scholar
  14. 14.
    Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993;16:65–68.PubMedGoogle Scholar
  15. 15.
    Grassi FA, Murena L, Valli F, Alberio R. Six-year experience with the Delta III reverse shoulder prosthesis. J Orthop Surg (Hong Kong). 2009;17:151–156.Google Scholar
  16. 16.
    Gutierrez S, Comiskey CA 4th, Luo ZP, Pupello DR, Frankle MA. 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;90:2606–2615.PubMedCrossRefGoogle Scholar
  17. 17.
    Herrmann S, Konig C, Heller M, Perka C, Greiner S. Reverse shoulder arthroplasty leads to significant biomechanical changes in the remaining rotator cuff. J Orthop Surg Res. 2011;6:42.PubMedCrossRefGoogle Scholar
  18. 18.
    Hughes RE, Niebur G, Liu J, An KN. Comparison of two methods for computing abduction moment arms of the rotator cuff. J Biomech. 1998;31:157–160.PubMedCrossRefGoogle Scholar
  19. 19.
    Lettin AW, Copeland SA, Scales JT. The Stanmore total shoulder replacement. J Bone Joint Surg Br. 1982;64:47–51.PubMedGoogle Scholar
  20. 20.
    Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res. 1993;291:20–28.PubMedGoogle Scholar
  21. 21.
    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;92:2544–2556.PubMedCrossRefGoogle Scholar
  22. 22.
    Nolan BM, Ankerson E, Wiater JM. Reverse total shoulder arthroplasty improves function in cuff tear arthropathy. Clin Orthop Relat Res. 2011;469:2476–2482.PubMedCrossRefGoogle Scholar
  23. 23.
    Post M, Haskell SS, Jablon M. Total shoulder replacement with a constrained prosthesis. J Bone Joint Surg Am. 1980;62:327–335.PubMedGoogle Scholar
  24. 24.
    Schneider PJ, Eberly DH. Least Squares Fitting. Geometric Tools for Computer Graphics. San Francisco, CA: Morgan Kaufmann Publishers; 2003:882–889.Google Scholar
  25. 25.
    Simovitch RW, Helmy N, Zumstein MA, Gerber C. Impact of fatty infiltration of the teres minor muscle on the outcome of reverse total shoulder arthroplasty. J Bone Joint Surg Am. 2007;89:934–939.PubMedCrossRefGoogle Scholar
  26. 26.
    Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Mole D. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff: results of a multicentre study of 80 shoulders. J Bone Joint Surg Br. 2004;86:388–395.PubMedCrossRefGoogle Scholar
  27. 27.
    Valenti P, Sauzieres P, Katz D, Kalouche I, Kilinc AS. Do less medialized reverse shoulder prostheses increase motion and reduce notching? Clin Orthop Relat Res. 2011;469:2550–2557.PubMedCrossRefGoogle Scholar
  28. 28.
    van der Helm FC. A finite element musculoskeletal model of the shoulder mechanism. J Biomech. 1994;27:551–569.PubMedCrossRefGoogle Scholar
  29. 29.
    Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87:1476–1486.PubMedCrossRefGoogle Scholar
  30. 30.
    Wu G, van der Helm FC, Veeger HE, Makhsous M, Van Roy P, Anglin C, Nagels J, Karduna AR, McQuade K, Wang X, Werner FW, Buchholz B; International Society of Biomechanics. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion: Part II. Shoulder, elbow, wrist and hand. J Biomech. 2005;38:981–992.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Stefan Greiner
    • 1
  • Christan Schmidt
    • 1
  • Christian König
    • 2
  • Carsten Perka
    • 1
  • Sebastian Herrmann
    • 1
  1. 1.Center for Musculoskeletal SurgeryCharité-University Medicine BerlinBerlinGermany
  2. 2.Julius Wolff InstituteCharité University Medicine BerlinBerlinGermany

Personalised recommendations