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The effect of subscapularis repair in reverse total shoulder arthroplasty depends on the design of the implant: a comparative study with a minimum 2-year follow-up

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The role of the subscapularis (Ssc) tendon does not yet have a well-defined role in RSA. The purpose of the present study was to evaluate if the repair of the Ssc in RSA improves overall clinical and radiographic results and if it has the same results using a medialized design humeral stem compared to a lateralized design.

Methods

Eighty-four consecutive patients undergoing RSA were retrospectively analyzed. Nine patients were lost at FU. Two implants with similar glenosphere design and different stem design (medialized and lateralized) were used. The Ssc was repaired in case of good quality of the fibers and reducibility without tension intraoperatively. Patients were divided into four groups for data analysis depending on whether they had received a medialized or lateralized design and Ssc repair or not. Patients were reviewed at an average follow-up of 40.8 ± 13.1 months. Clinical outcome measures included Active range of motion (ROM), strength, visual analog scale (VAS), Constant-Murley score (CMS), and the American Shoulder and Elbow Surgeons score (ASES). Radiographic evaluation at final follow-up was performed to assess scapular notching, stress shielding, and radiolucent lines.

Results

No statistically significant clinical differences (p > 0.05) emerged between Lat/Ssc+ and Lat/Ssc–. Conversely, the patients belonging to the Med/Ssc– group reported statistically worse (p < 0.05) results than the Med/Ssc + group in terms of VAS, ASES and CMS. Statistically worse (p < .05) results in the Med/Ssc– group than in the Med/Ssc + were found also in active ROM achieved in FE, ABD, ER1 and ER2, and in the strength obtained in FE, ABD and ER2. Scapular notching was reported in 3 shoulders (15.7%) in Lat/Ssc+ group and in 7 shoulders (50%) in Lat/Ssc– group, while it was reported in 4 shoulders (14.2%) in Med/Ssc + group and in 6 shoulders (42.8%) in Med/Ssc– group. Stress shielding was observed in 6 cases in Lat/Ssc+ group (31.6%), in 8 cases in Lat/Ssc– group (57.1%), in 3 cases (10.7%) in Med/Ssc + group and 4 cases in Med/Ssc– group (28.6%).

Conclusions

Patients undergoing RSA show clinical improvements at mid-term follow-up with a low rate of complications, regardless of the use of a medialized or a lateralized humeral stem design. Ssc repair is associated with better functional outcomes in the cohort of medialized stem, while it did not yield significant differences in the cohort of lateralized stem.

Level of evidence

Level III; Retrospective Cohort Comparison; Treatment Study.

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Data availability

The data that support the findings of this study are available from the authors upon reasonable request.

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Authors and Affiliations

  1. Casa di Cura Villa Betania, Rome, Italy

    Fabrizio Mocini, Simone Cerciello, Luca Saturnino & Matthew C. Giordano

  2. A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy

    Simone Cerciello

  3. Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy

    Katia Corona

  4. Baptist Health Medical Group Orthopedics and Sports Medicine, Lexington, KY, USA

    Brent J. Morris

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  1. Fabrizio Mocini
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Correspondence to Fabrizio Mocini.

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Mocini, F., Cerciello, S., Corona, K. et al. The effect of subscapularis repair in reverse total shoulder arthroplasty depends on the design of the implant: a comparative study with a minimum 2-year follow-up. Arch Orthop Trauma Surg 144, 41–49 (2024). https://doi.org/10.1007/s00402-023-05025-3

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