Restoration of External Rotation Following a Lateral Approach for Glenoid Bony Increased-Offset Reverse Shoulder...

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Reconstructive Surgery

Background:

• Reverse shoulder arthroplasty (RSA) is a treatment for massive rotator cuff tears.
• The role of bony increased offset (BIO) and lateral approach (LA) in RSA for improving external rotation remains debated.
• Conventional deltopectoral approach for RSA involves subscapularis tendon sacrifice.

Purpose of the Study:

• To evaluate the effectiveness of a lateral approach (LA) for RSA with bony increased offset (BIO) in restoring external rotation.
• To compare outcomes of LA RSA with BIO versus without BIO in patients with massive rotator cuff tears.
• To assess the impact of LA RSA with BIO on range of motion and functional scores.

Main Methods:

• Retrospective study comparing 36 LA non-BIO RSAs and 40 LA BIO RSAs for massive rotator cuff tears.
• Patient groups included those with combined loss of active elevation and external rotation (CLEER).
• Outcomes measured included Constant score, UCLA score, and range of motion (ER0, ER90, anterior elevation).

Main Results:

• LA BIO-RSA significantly improved mean ER90 (65.9°) compared to LA non-BIO-RSA (53.0°).
• For patients with CLEER, LA BIO-RSA significantly improved mean ER0 from -15.8° to 11.0°.
• While anterior elevation, UCLA, and Constant scores improved in both groups, no significant difference was found between LA BIO-RSA and LA non-BIO-RSA.

Conclusions:

• LA BIO-RSA demonstrates significant improvement in range of motion, particularly external rotation.
• LA BIO-RSA offers benefits for patients with massive rotator cuff tears, especially those with combined loss of elevation and rotation.
• Improvements in anterior elevation and functional scores were comparable between LA BIO-RSA and LA non-BIO-RSA.