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Review
. 2021 Jul 6;10(14):3014.
doi: 10.3390/jcm10143014.

Clinical Outcomes and Joint Stability after Lateralized Reverse Total Shoulder Arthroplasty with and without Subscapularis Repair: A Meta-Analysis

Katia Corona  1 , Simone Cerciello  2   3   4 , Gianluca Ciolli  2 , Lorenzo Proietti  3 , Riccardo D'Ambrosi  5 , Adriano Braile  6 , Giuseppe Toro  6 , Alfonso Maria Romano  7   8 , Francesco Ascione  7   8
Affiliations
Review

Clinical Outcomes and Joint Stability after Lateralized Reverse Total Shoulder Arthroplasty with and without Subscapularis Repair: A Meta-Analysis

Katia Corona et al. J Clin Med. .

Abstract

Introduction: Subscapularis tendon repair in reverse total shoulder arthroplasty represents a potentially modifiable risk factor for dislocation, and its role continues to be debated. The purpose of the present meta-analysis was to compare the outcomes of the primary lateralized RSAs with and without subscapularis repair in terms of range of motion, clinical outcomes, dislocations, and complications rate.

Materials and methods: A systematic literature search in MEDLINE (Pubmed), Embase, and the Cochrane Central Register of Controlled Trials database was carried up to December 2020. A data extraction form was developed to collect select data from the included studies. The methodological quality was assessed using a Methodological Index for Nonrandomized Studies (MINORS) score. Statistical analysis was performed with Review Manager (Version 5.4, The Cochrane Collaboration).

Results: A total of four comparative studies involving 978 patients were included. In the pooled analysis, the reinsertion of the subscapularis yielded better functional outcomes in terms of the constant (P < 0.00001) and ASES (P = 0.002) scores. The forward elevation, external rotation at 0°, internal rotation, and dislocation rates were comparable between the two groups (P = n.s.), while statistically increased abduction was observed in those patients who did not have their subscapularis repaired (P < 0.00001).

Conclusion: The results of the present findings suggest that it seems reasonable to reinsert the subscapularis whenever it is present, in good tissue conditions, and with no evidence of fatty degeneration of its muscle belly.

Level of evidence: Level III meta-analysis.

Keywords: clinical outcomes; complication rates; dislocation; lateralized reverse shoulder arthroplasty; meta-analysis; subscapularis repair.

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Conflict of interest statement

Simone Cerciello and Lorenzo Proietti are private practice employers and they declare no conflict of interest. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart of the paper selection process.
Figure 2
Figure 2
Forest plots of primary outcomes.
Figure 2
Figure 2
Forest plots of primary outcomes.
Figure 3
Figure 3
Forest plots of secondary outcomes.
Figure 4
Figure 4
Forest plots of dislocations rates.
See this image and copyright information in PMC

References

    1. Chan K., Langohr G.D.G., Mahaffy M., Johnson J.A., Athwal G.S. Does humeral component lateralization in reverse shoulder arthroplasty affect rotator cuff torque? Evaluation in a cadaver model. Clin. Orthop. Relat. Res. 2017;475:2564–2571. doi: 10.1007/s11999-017-5413-7. - DOI - PMC - PubMed
    1. Costantini O., Choi D.S., Kontaxis A., Gulotta L.V. The effects of progressive lateralization of the joint center of rotation of reverse total shoulder implants. J. Shoulder Elb. Surg. 2015;24:1120–1128. doi: 10.1016/j.jse.2014.11.040. - DOI - PubMed
    1. Giles J.W., Langohr G.D., Johnson J.A., Athwal G.S. The rotator cuff muscles are antagonists after reverse total shoulder arthroplasty. J. Shoulder Elb. Surg. 2016;25:1592–1600. doi: 10.1016/j.jse.2016.02.028. - DOI - PubMed
    1. Henninger H.B., Barg A., Anderson A.E., Bachus K.N., Burks R.T., Tashjian R.Z. Effect of lateral offset center of rotation in reverse total shoulder arthroplasty: A biomechanical study. J. Shoulder Elb. Surg. 2012;21:1128–1135. doi: 10.1016/j.jse.2011.07.034. - DOI - PubMed
    1. Langohr G.D., Giles J.W., Athwal G.S., Johnson J.A. The effects of glenosphere diameter in reverse shoulder arthroplasty on muscle force, joint load, and range of motion. J. Shoulder Elb. Surg. 2015;24:972–979. doi: 10.1016/j.jse.2014.10.018. - DOI - PubMed