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Surgical Technique: The Anterosuperior Approach for Reverse Shoulder Arthroplasty

  • Symposium: Reverse Total Shoulder Arthroplasty
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The anterosuperior approach used for reverse shoulder arthroplasty is an intermediate between the transacromial approach originally proposed by Paul Grammont and the anterosuperior approach described by D. B. Mackenzie for shoulder arthroplasty. As an alternative to the deltopectoral approach, the anterosuperior approach has the advantages of simplicity and postoperative stability.

Description of Technique

The anterior deltoid is divided from the anterior edge of the acromioclavicular arch, allowing exposure to the glenoid for glenosphere implantation.

Patients and Methods

We used the findings of published studies to assess instability, function and pain scores, scapular notching, and complications after this approach.

Results

In a comparison of the deltopectoral and anterosuperior approaches in 527 reverse arthroplasties with a minimum 2-year followup, postoperative instability rate was greater with the deltopectoral (5.1%) than with the anterosuperior (0.8%) approach. Other published studies confirm this finding. No differences in Constant-Murley score or active mobility were found. Scapular notching occurred at similar rates after the anterosuperior (74%) and deltopectoral (63%) approaches. Humeral diaphyseal fracture rates were similar, whereas the acromial fracture rate was higher using the deltopectoral approach. Loosening tended to occur more often with the anterosuperior approach.

Conclusions

The anterosuperior approach can be used in primary and revision reverse shoulder arthroplasty, as well as in acute humeral head fracture. Its main apparent advantages are simplicity, ease of axial humerus preparation, quality of frontal exposure of the glenoid, and due to subscapularis tendon preservation, a low risk of postoperative instability. Its drawbacks are risk of inaccurate glenoid positioning, axillary nerve palsy, and deltoid weakening.

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Authors and Affiliations

  1. Clinique de Traumatologie et d’Orthopédie, 49 rue Hermite, 54000, Nancy, France

    Daniel Molé MD, Frank Wein MD, Charles Dézaly MD & François Sirveaux MD

  2. Shoulder Unit, Institut de la main, Paris, France

    Philippe Valenti MD

Authors
  1. Daniel Molé MD
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  2. Frank Wein MD
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  3. Charles Dézaly MD
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  4. Philippe Valenti MD
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  5. François Sirveaux MD
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Corresponding author

Correspondence to Daniel Molé MD.

Additional information

Each author certifies that he has no commercial association (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Clinique de Traumatologie et d’Orthopedie.

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Molé, D., Wein, F., Dézaly, C. et al. Surgical Technique: The Anterosuperior Approach for Reverse Shoulder Arthroplasty. Clin Orthop Relat Res 469, 2461–2468 (2011). https://doi.org/10.1007/s11999-011-1861-7

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  • DOI: https://doi.org/10.1007/s11999-011-1861-7

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