Repairability of the subscapularis tendon in reverse shoulder prosthesis according to radiological findings

Abstract

Shoulder function is important in patients who underwent reverse shoulder prosthesis surgery for cuff tear arthropathy in the postoperative period to implement their daily routines. Therefore, we aimed to predict the repairability of the subscapularis tendon in reverse shoulder arthroplasty by looking at the radiological findings. A total of 107 shoulders of 101 patients were examined retrospectively. Preoperative and postoperative shoulder AP radiographs of the patients were evaluated according to acromiohumeral distance, lateral humeral offset, acromiohumeral distance difference, lateral humeral offset difference, Hamada classification, and rotator cuff Goutallier staging. The subscapularis tendon could not be repaired in 31 (28.97%) of 107 shoulders and could not be repaired in 13 of 17 patients who used an onlay prosthesis. There was no significant correlation between preoperative Hamada staging, preoperative lateral humeral offset and lateral humeral offset difference, and subscapularis repair (p < 0.05). Preoperative and postoperative acromiohumeral distance cut-off values were found to be 0.59 and 3.22 cm, respectively. A statistically significant correlation was found in terms of preoperative acromiohumeral distance, postoperative acromiohumeral distance, acromiohumeral distance difference, Goutallier stage with the repair of subscapularis tendon. Fatty atrophy in rotator cuff muscles and distalization of the humerus can be considered as negative predictive values in terms of repairability of the subscapularis tendon.

Keywords

Acromiohumeral distance lateral humeral offset radiological findings reverse shoulder prosthesis shoulder subscapularis repair

Get full access to this article

View all access options for this article.

References

Gerber

Canonica

Catanzaro

, et al. Longitudinal observational study of reverse total shoulder arthroplasty for irreparable rotator cuff dysfunction: results after 15 years. J Shoulder Elbow Surg 2018; 27: 831–838.

Kim

Jeong

Kim

, et al. Difficulty in performing activities of daily living associated with internal rotation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29: 86–94.

Liou

Yang

Petersen-Fitts

, et al. Effect of lateralized design on muscle and joint reaction forces for reverse shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26: 564–572.

Werner

Lederman

Gobezie

, et al. Glenoid lateralization influences active internal rotation after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30: 2498–2505.

Giles

Langohr

GDG

Johnson

, et al. The rotator cuff muscles are antagonists after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2016; 25: 1592–1600.

Friedman

Flurin

P-H

Wright

, et al. Comparison of reverse total shoulder arthroplasty outcomes with and without subscapularis repair. J Shoulder Elbow Surg 2017; 26: 662–668.

Sanders

Jersey

. Conventional radiography of the shoulder. Semin Roentgenol 2005; 40: 207–22.

Hamada

Yamanaka

Uchiyama

, et al. A radiographic classification of massive rotator cuff tear arthritis. Clin Orthop Relat Res 2011; 469: 2452–2460.

Somerson

Hsu

Gorbaty

, et al. Classifications in brief: Goutallier classification of fatty infiltration of the rotator cuff musculature. Clin Orthop Relat Res 2016; 474: 1328–1332.

10.

Hochreiter

Hasler

, et al. Factors influencing functional internal rotation after reverse total shoulder arthroplasty. JSES Int 2021; 5: 679–687.

11.

Cohen

. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum, 1988.

12.

Jeon

Rhee

. Factors associated with poor active anterior elevation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27: 786–793.

13.

Engel

Holschen

Schorn

, et al. Results after primary reverse shoulder arthroplasty with and without subscapularis repair: a prospective-randomized trial. Arch Ortho Trauma Surg 2023; 143: 255–264.

14.

Bigdon

Bolliger

Albers

, et al. Subscapularis in reverse total shoulder arthroplasty. J Shoulder Elb Arthroplast 2019; 3: 2471549219834192.

15.

Ackland

Richardson

Pandy

. Axial rotation moment arms of the shoulder musculature after reverse total shoulder arthroplasty. J Bone Joint Surg Am 2012; 94: 1886–1895.

16.

Shin

McGarry

, et al. Biomechanical effects of humeral neck-shaft angle and subscapularis integrity in reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2014; 23: 1091–1098.

17.

Roberson

Shanley

Griscom

, et al. Subscapularis repair is unnecessary after lateralized reverse shoulder arthroplasty. JB JS Open Access 2018; 3: e0056.

18.

Onstot

, et al. Consequences of concomitant subscapularis repair with reverse total shoulder arthroplasty. In: 58th Annual Meeting of the Orthopaedic Research Society. 2012.

19.

Hasegawa

Mihata

Fukunishi

, et al. Relationship between the Hamada grade and underlying pathological conditions in the rotator cuff and long head of biceps in symptomatic patients with rotator cuff tears. JSES Int 2022; 6: 488–494.

20.

Monroe

Flores

Zhang

, et al.

Do outcomes of arthroscopic subscapularis tendon repairs depend on rotator cuff fatty infiltration?

Orthop J Sports Med 2020; 8: 2325967120913036.

21.

Boutsiadis

Lenoir

Denard

, et al. The lateralization and distalization shoulder angles are important determinants of clinical outcomes in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27: 1226–1234.

22.

Boileau

Watkinson

Hatzidakis

, et al. 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.