Abstract
Introduction
Limitation of active Internal Rotation (IR) following Reverse Shoulder Arthroplasty (RSA) in patients with massive Rotator Cuff Tears (mRCTs) with subscapularis insufficiency remains a challenge. Recently, RSA with Latissimus dorsi and Teres major (LDTM) transfer in patients with limited active IR has been demonstrated as a reliable treatment option. The purpose of this study was to biomechanically compare the IR torque following LDTM transfer with RSA in mRCT with subscapularis insufficiency to RSA without tendon transfer.
Methods
Eight cadaveric shoulders were tested (mean age: 64.5 ± 1.9 years) using a custom shoulder testing system that permits loading conditions of mRCT with subscapularis insufficiency. Two conditions were tested and compared. The first condition was RSA alone and the second condition was RSA with LDTM transfer. RSA with a medialized glenoid and lateralized humerus design was used for all specimens. The specimens were tested at 0°, 20° and 40° abduction at three different muscle loads: baseline, double, and triple, while the Teres minor and deltoid loads were kept constant. IR torque was measured with a torque wrench at 0°, 20°, and 40° abduction and 60° and 45° IR positions. Force required for anterior dislocation was measured at 20° abduction and 10° IR position.
Results
RSA with LDTM transfer had significantly higher IR torque at all abductions and muscle loading compared with RSA without transfer (average at all positions; RSA without transfer: 0.80 ± 0.02 Nm, LDTM transfer for all loads: 1.43 ± 0.10 Nm). RSA with LDTM transfer (91.4 ± 3.9 N) needed higher force for anterior dislocation compared to RSA alone (89.4 ± 4.1 N), but there was no significant difference.
Conclusion
LDTM transfer with RSA increases IR torque compared to RSA without tendon transfer in a cadaveric model. LDTM transfer with RSA may be a reliable treatment option for patients with mRCT and subscapularis insufficiency who are expected to have limited active IR following RSA.
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Data availability
Data are available upon reasonable request.
References
Boileau P, Watkinson DJ, Hatzidakis AM, Balg F (2005) Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg 14(1 Suppl S):147–161. https://doi.org/10.1016/j.jse.2004.10.006
Drake GN, O’Connor DP, Edwards TB (2010) Indications for reverse total shoulder arthroplasty in rotator cuff disease. Clin Orthop Relat Res 468(6):1526–1533. https://doi.org/10.1007/s11999-009-1188-9
Holcomb JO, Cuff D, Petersen SA, Pupello DR, Frankle MA (2009) Revision reverse shoulder arthroplasty for glenoid baseplate failure after primary reverse shoulder arthroplasty. J Shoulder Elb Surg 18(5):717–723. https://doi.org/10.1016/j.jse.2008.11.017
Clouthier AL, Hetzler MA, Fedorak G, Bryant JT, Deluzio KJ, Bicknell RT (2013) Factors affecting the stability of reverse shoulder arthroplasty: a biomechanical study. J Shoulder Elb Surg 22(4):439–444. https://doi.org/10.1016/j.jse.2012.05.032
Gutiérrez S, Levy JC, Frankle MA, Cuff D, Keller TS, Pupello DR et al (2008) Evaluation of abduction range of motion and avoidance of inferior scapular impingement in a reverse shoulder model. J Shoulder Elb Surg 17(4):608–615. https://doi.org/10.1016/j.jse.2007.11.010
Kontaxis A, Chen X, Berhouet J, Choi D, Wright T, Dines DM et al (2017) Humeral version in reverse shoulder arthroplasty affects impingement in activities of daily living. J Shoulder Elb Surg 26(6):1073–1082. https://doi.org/10.1016/j.jse.2016.11.052
Liou W, Yang Y, Petersen-Fitts GR, Lombardo DJ, Stine S, Sabesan VJ (2017) Effect of lateralized design on muscle and joint reaction forces for reverse shoulder arthroplasty. J Shoulder Elb Surg 26(4):564–572. https://doi.org/10.1016/j.jse.2016.09.045
Nyffeler RW, Werner CM, Gerber C (2005) Biomechanical relevance of glenoid component positioning in the reverse Delta III total shoulder prosthesis. J Shoulder Elb Surg 14(5):524–528. https://doi.org/10.1016/j.jse.2004.09.010
Streit JJ, Shishani Y, Gobezie R (2015) Medialized versus lateralized center of rotation in reverse shoulder arthroplasty. Orthopedics 38(12):e1098–e1103. https://doi.org/10.3928/01477447-20151120-06
Gerber C, Pennington SD, Lingenfelter EJ, Sukthankar A (2007) Reverse Delta-III total shoulder replacement combined with latissimus dorsi transfer. A preliminary report. J Bone Jt Surg Am Vol 89(5):940–947. https://doi.org/10.2106/jbjs.F.00955
Kim MS, Jeong HY, Kim JD, Ro KH, Rhee SM, Rhee YG (2020) Difficulty in performing activities of daily living associated with internal rotation after reverse total shoulder arthroplasty. J Shoulder Elb Surg 29(1):86–94. https://doi.org/10.1016/j.jse.2019.05.031
Rojas J, Joseph J, Liu B, Srikumaran U, McFarland EG (2018) Can patients manage toileting after reverse total shoulder arthroplasty? A systematic review. Int Orthop 42(10):2423–2428. https://doi.org/10.1007/s00264-018-3900-4
Boileau P, Rumian AP, Zumstein MA (2010) Reversed shoulder arthroplasty with modified L’Episcopo for combined loss of active elevation and external rotation. J Shoulder Elb Surg 19(2 Suppl):20–30. https://doi.org/10.1016/j.jse.2009.12.011
Boileau P, Chuinard C, Roussanne Y, Neyton L, Trojani C (2007) 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 Elb Surg 16(6):671–682. https://doi.org/10.1016/j.jse.2007.02.127
Shi LL, Cahill KE, Ek ET, Tompson JD, Higgins LD, Warner JJ (2015) Latissimus Dorsi and Teres major transfer with reverse shoulder arthroplasty restores active motion and reduces pain for posterosuperior cuff dysfunction. Clin Orthop Relat Res 473(10):3212–3217. https://doi.org/10.1007/s11999-015-4433-4
Young BL, Connor PM, Schiffern SC, Roberts KM, Hamid N (2020) 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. J Shoulder Elb Surg 29(5):874–881. https://doi.org/10.1016/j.jse.2019.12.024
Werthel JD, Schoch BS, Hooke A, Sperling JW, An KN, Valenti P et al (2021) Biomechanical effectiveness of tendon transfers to restore active internal rotation in shoulder with deficient subscapularis with and without reverse shoulder arthroplasty. J Shoulder Elb Surg 30(5):1196–1206. https://doi.org/10.1016/j.jse.2020.08.026
Chan K, Langohr GDG, Athwal GS, Johnson JA (2022) The biomechanical effectiveness of tendon transfers to restore rotation after reverse shoulder arthroplasty: latissimus versus lower trapezius. Should Elb 14(1):48–54. https://doi.org/10.1177/1758573220946257
Baek CH, Kim JG, Baek GR (2022) Restoration of active internal rotation following reverse shoulder arthroplasty: anterior latissimus dorsi and teres major combined transfer. J Shoulder Elb Surg 31(6):1154–1165. https://doi.org/10.1016/j.jse.2021.11.008
Baek CH, Kim JG, Baek GR (2022) Outcomes of combined anterior latissimus dorsi and teres major tendon transfer for irreparable anterosuperior rotator cuff tears. J Shoulder Elb Surg 31(11):2298–2307. https://doi.org/10.1016/j.jse.2022.03.025
Werthel JD, Walch G, Vegehan E, Deransart P, Sanchez-Sotelo J, Valenti P (2019) Lateralization in reverse shoulder arthroplasty: a descriptive analysis of different implants in current practice. Int Orthop 43(10):2349–2360. https://doi.org/10.1007/s00264-019-04365-3
Gutiérrez S, Comiskey CA, Luo ZP, Pupello DR, Frankle MA (2008) Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors. J Bone Jt Surg Am Vol 90(12):2606–2615. https://doi.org/10.2106/jbjs.H.00012
Gutiérrez S, Greiwe RM, Frankle MA, Siegal S, Lee WE 3rd (2007) Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis. J Shoulder Elb Surg 16(3 Suppl):S9-s12. https://doi.org/10.1016/j.jse.2005.11.008
Berhouet J, Garaud P, Favard L (2014) Evaluation of the role of glenosphere design and humeral component retroversion in avoiding scapular notching during reverse shoulder arthroplasty. J Shoulder Elb Surg 23(2):151–158. https://doi.org/10.1016/j.jse.2013.05.009
Gulotta LV, Choi D, Marinello P, Knutson Z, Lipman J, Wright T et al (2012) Humeral component retroversion in reverse total shoulder arthroplasty: a biomechanical study. J Shoulder Elb Surg 21(9):1121–1127. https://doi.org/10.1016/j.jse.2011.07.027
Erickson BJ, Shishani Y, Bishop ME, Patel M, Jones S, Romeo AA et al (2020) Subscapularis repair during reverse total shoulder arthroplasty using a stem-based double-row repair: sonographic and clinical outcomes. Orthop J Sports Med 8(3):2325967120906806. https://doi.org/10.1177/2325967120906806
Baek GR, Kim JG, Kwak D, Nakla AP, Chung MS, McGarry MH et al (2022) Biomechanical comparison of combined latissimus Dorsi and Teres major tendon transfer versus latissimus Dorsi tendon transfer in shoulders with irreparable anterosuperior rotator cuff tears. J Shoulder Elb Surg. https://doi.org/10.1016/j.jse.2022.11.007
Oh JH, Shin SJ, McGarry MH, Scott JH, Heckmann N, Lee TQ (2014) Biomechanical effects of humeral neck-shaft angle and subscapularis integrity in reverse total shoulder arthroplasty. J Shoulder Elb Surg 23(8):1091–1098. https://doi.org/10.1016/j.jse.2013.11.003
Lichtenberg S, Magosch P, Habermeyer P (2012) Are there advantages of the combined latissimus-dorsi transfer according to L’Episcopo compared to the isolated latissimus-dorsi transfer according to Herzberg after a mean follow-up of 6 years? A matched-pair analysis. J Shoulder Elb Surg 21(11):1499–1507. https://doi.org/10.1016/j.jse.2012.01.002
Mulla DM, Hodder JN, Maly MR, Lyons JL, Keir PJ (2020) Glenohumeral stabilizing roles of the scapulohumeral muscles: implications of muscle geometry. J Biomech 100:109589. https://doi.org/10.1016/j.jbiomech.2019.109589
Ferle M, Pastor MF, Hagenah J, Hurschler C, Smith T (2019) Effect of the humeral neck-shaft angle and glenosphere lateralization on stability of reverse shoulder arthroplasty: a cadaveric study. J Shoulder Elb Surg 28(5):966–973. https://doi.org/10.1016/j.jse.2018.10.025
Henninger HB, Barg A, Anderson AE, Bachus KN, Burks RT, Tashjian RZ (2012) Effect of lateral offset center of rotation in reverse total shoulder arthroplasty: a biomechanical study. J Shoulder Elb Surg 21(9):1128–1135. https://doi.org/10.1016/j.jse.2011.07.034
Franceschetti E, de Sanctis EG, Ranieri R, Palumbo A, Paciotti M, Franceschi F (2019) The role of the subscapularis tendon in a lateralized reverse total shoulder arthroplasty: repair versus nonrepair. Int Orthop 43(11):2579–2586. https://doi.org/10.1007/s00264-018-4275-2
Friedman RJ, Flurin PH, Wright TW, Zuckerman JD, Roche CP (2017) Comparison of reverse total shoulder arthroplasty outcomes with and without subscapularis repair. J Shoulder Elb Surg 26(4):662–668. https://doi.org/10.1016/j.jse.2016.09.027
Vourazeris JD, Wright TW, Struk AM, King JJ, Farmer KW (2017) Primary reverse total shoulder arthroplasty outcomes in patients with subscapularis repair versus tenotomy. J Shoulder Elb Surg 26(3):450–457. https://doi.org/10.1016/j.jse.2016.09.017
Werner BC, Wong AC, Mahony GT, Craig EV, Dines DM, Warren RF et al (2018) Clinical outcomes after reverse shoulder arthroplasty with and without subscapularis repair: the importance of considering glenosphere lateralization. J Am Acad Orthop Surg 26(5):e114–e119. https://doi.org/10.5435/jaaos-d-16-00781
Funding
Funding for this study was provided by Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea. The funding source did not play a role in the investigation.
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All authors contributed to the study conception and design. Methodology: MHM, MS; TQL, Ph.D.; data collection and analysis were performed by GRB, BS; CHB, MD; JGK, MD; Gyuna Baek; M-SC, BS; OK, BS; MHM, MS. Funding acquisition: TQL, Ph.D. The first draft of the manuscript was written by GRB, BS and JGK, MD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Investigation performed at Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.
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Baek, G.R., Kim, J.G., Baek, C.H. et al. Latissimus Dorsi and Teres major tendon transfer increases internal rotation torque following lateralized reverse shoulder arthroplasty with subscapularis insufficiency. Arch Orthop Trauma Surg 143, 5759–5766 (2023). https://doi.org/10.1007/s00402-023-04861-7
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DOI: https://doi.org/10.1007/s00402-023-04861-7