The role of the subscapularis tendon in a lateralized reverse total shoulder arthroplasty: repair versus nonrepair



The reverse shoulder prost hesis (rTSA) is now implanted by the same percentage of anatomic shoulder prosthesis in the USA. Scapular notching and loss of extrarotation have been underlined as complication at long-term follow-up due to the Grammont design. The current trend to reduce those limits is to position both components lateralized. As the role of the subscapularis tendon in this new rTSA design is unclear, the purpose of this study is to quantify rTSA outcomes in patients with or without subscapularis tendon suture.


The surgery was performed by the same orthopaedic surgeon (F.F.), using a Aequalis Ascend™ Flex prosthesis (Tornier, Montbonnot, France) with a bone autograft.

Forty-four patients underwent surgery with the tendon sutured, whereas 40 patients underwent the same surgery without repairing it.

Patients were evaluated pre-operatively and at the last follow-up using Constant score, VAS, and ROM. The minimum and mean follow-ups were six and 16.6 months, respectively.


All patients showed statistically significant improvement in pain and joint function following surgery. This study highlighted significant higher values in intrarotation and abduction, respectively, with and without suturing the subscapularis tendon.

However, no significant differences were underlined in Constant score, VAS, forward flexion, extrarotation at 0° and 90° of abduction, and rate of instability.


As predicted, significant clinical improvements were observed in both groups with some differences.

These clinical results showed that the use of rTSA with lateralized humerus and bony increase offset leads to realistic clinical improvements with a low risk of instability without the need for compression and stabilization of the tendon.

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Suturing the subscapularis tendon does not lead to inferior clinical results as predicted by biomechanical models [25, 35].

Likewise, not repairing the tendon with a lateralized humerus does not result in higher scores or greater range of motion.

Moreover, no difference was observed in the rates of complications between patients with or without suture.

The difference of the designs (lateral versus medial) used can partially explain the contradictory results in the scientific literature.

Longer follow-ups, greater number of patients, and multiple score use are important to confirm our results.

A potential future study on the role of the subscapularis in the rTSA should stratify all patients undergoing surgery performed by the same surgeon in four groups according to the prosthetic design (Grammont design, medial glenosphere and lateral humerus, lateral glenosphere and medial humerus, both lateral).

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Correspondence to Francesco Franceschi.

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Franceschetti, E., de Sanctis, E.G., Ranieri, R. et al. The role of the subscapularis tendon in a lateralized reverse total shoulder arthroplasty: repair versus nonrepair. International Orthopaedics (SICOT) 43, 2579–2586 (2019).

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  • Reverse total shoulder arthroplasty
  • Subscapularis tendon
  • Cuff tear arthropathy