TY - JOUR
T1 - Role of the remaining rotator cuff following reverse total shoulder arthroplasty
AU - Knapik, Derrick M.
AU - Voos, James E.
AU - Salata, Michael J.
AU - Gillespie, Robert J.
N1 - Publisher Copyright:
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016
Y1 - 2016
N2 - Rotator cuff degeneration and cuff tear arthropathy result from chronic degeneration and wear, representing a significant clinical and financial burden in the elderly population. Reverse shoulder arthroplasty (RSA) has proven to be superior in restoring clinical and functional outcomes in patients not amendable to direct rotator cuff repair when compared with total shoulder arthroplasty. However, the design of the reverse shoulder prosthesis fails to restore external rotation in the setting of massive posterior rotator cuff tears with a dislocation rates as high as 9%. This necessitates a review of the role of the remaining posterior rotator cuff (infraspinatus and teres minor) and subscapularis on postoperative clinical and functional outcomes after RSA. On the basis of the available literature, the health of the posterior rotator cuff, reflected in the degree of fatty infiltration and tearing, is essential for maintenance and restoration of external rotation postoperatively, with the integrity of the teres minor being more critical. Proper tensioning of the posterior cuff using increased offset designs is necessary to achieve optimal outcomes. However, tendon transfers using the latissimus dorsi, with or without the teres major, make the contribution of the remaining posterior rotator cuff on postoperative outcomes negligible. Meanwhile, subscapularis repair and integrity are not critical to postoperative stability of the prosthesis or internal rotation. Further investigations are warranted to determine the amount of remaining rotator cuff and the extent of degeneration necessary to impact postoperative outcomes after RSA.
AB - Rotator cuff degeneration and cuff tear arthropathy result from chronic degeneration and wear, representing a significant clinical and financial burden in the elderly population. Reverse shoulder arthroplasty (RSA) has proven to be superior in restoring clinical and functional outcomes in patients not amendable to direct rotator cuff repair when compared with total shoulder arthroplasty. However, the design of the reverse shoulder prosthesis fails to restore external rotation in the setting of massive posterior rotator cuff tears with a dislocation rates as high as 9%. This necessitates a review of the role of the remaining posterior rotator cuff (infraspinatus and teres minor) and subscapularis on postoperative clinical and functional outcomes after RSA. On the basis of the available literature, the health of the posterior rotator cuff, reflected in the degree of fatty infiltration and tearing, is essential for maintenance and restoration of external rotation postoperatively, with the integrity of the teres minor being more critical. Proper tensioning of the posterior cuff using increased offset designs is necessary to achieve optimal outcomes. However, tendon transfers using the latissimus dorsi, with or without the teres major, make the contribution of the remaining posterior rotator cuff on postoperative outcomes negligible. Meanwhile, subscapularis repair and integrity are not critical to postoperative stability of the prosthesis or internal rotation. Further investigations are warranted to determine the amount of remaining rotator cuff and the extent of degeneration necessary to impact postoperative outcomes after RSA.
KW - Infraspinatus
KW - Postoperative outcomes
KW - Reverse shoulder arthroplasty
KW - Rotator cuff
KW - RSA
KW - Subscapularis
KW - Teres minor
UR - http://www.scopus.com/inward/record.url?scp=84971499055&partnerID=8YFLogxK
U2 - 10.1097/BTO.0000000000000172
DO - 10.1097/BTO.0000000000000172
M3 - Article
AN - SCOPUS:84971499055
SN - 0885-9698
VL - 31
SP - 114
EP - 119
JO - Techniques in Orthopaedics
JF - Techniques in Orthopaedics
IS - 2
ER -