How to Optimize Reverse Shoulder Arthroplasty for Irreparable Cuff Tears
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SURGICAL MANAGEMENT OF MASSIVE IRREPARABLE CUFF TEARS (J SANCHEZ-SOTELO, SECTION EDITOR)
How to Optimize Reverse Shoulder Arthroplasty for Irreparable Cuff Tears Joaquin Sanchez-Sotelo 1 & George S. Athwal 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of the Review Reverse shoulder arthroplasty (RSA) is commonly considered as one of the options for surgical management of the functionally irreparable rotator cuff tear (FIRCT). This article reviews tips and tricks to optimize the outcome of RSA when performed specifically for this indication. Recent Findings RSA has been reported to provide satisfactory outcomes in a large proportion of patients with FIRCTs. However, subjective satisfaction is lesser in patients with well-maintained preoperative motion as well as those with isolated loss of active external rotation. The popularity of implants that provide some degree of global lateralization continues to increase. Optimizing the outcome of RSA for FIRCTs requires a careful balance between minimizing perimeter impingement and enhancing the function of intact muscles, in particular the deltoid and any remaining rotator cuff. Controversy continues regarding the benefits and disadvantages of subscapularis repair at the time of RSA. Tendon and muscle transfers performed at the time of RSA have the potential to optimize the outcome in selected patients with profound weakness in external rotation or those with severe deltoid dysfunction. Summary When RSA is considered for patients with a FIRCT without arthritis, careful attention to indications and technical pearls may contribute to optimize outcomes. Keywords Rotator cuff repair . Reverse shoulderarthroplasty . Cuff teararthropathy . Tendon transfers . Latissimusdorsi . Massive irreparable cuff tear
Introduction Reverse shoulder arthroplasty (RSA) was designed to improve the outcome of shoulder replacement in the setting of rotator cuff insufficiency [1••]. Although cuff-tear arthropathy was the main condition managed with RSA initially [2], indications for this procedure expanded to other disorders, including the functionally irreparable rotator cuff tear (FIRCT) without arthropathy [3]. Many people around the world with This article is part of the Topical Collection on Surgical Management of Massive Irreparable Cuff Tears * Joaquin Sanchez-Sotelo [email protected] 1
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
2
Roth McFarlane Centre, London, ON, Canada
FIRCTs have benefited from RSA. However, a proportion of patients who undergo RSA specifically for FIRCT do not do as well [4••]. In addition, RSA comes with some limitations— namely unpredictable restoration of axial rotation—and potential complications, including dislocation and postoperative fractures of the scapular acromion or spine [5]. Over the last two decades, the designs of RSA implants have been modified and expanded substantially, and many of the prosthesis available today vary widely [6••]. In parallel, a number of salvage pro
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