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
Highlights
Subscapularis tendon repair in reverse total shoulder arthroplasty represents a potentially modifiable risk factor for dislocation, and its role continues to be debated
Other surgeons argue that reinserting the SSc limits external rotation and abduction and is biomechanically adverse for deltoid function, as the SSc functions as an adductor in the reverse total shoulder arthroplasty (RSA), necessitating the deltoid function to facilitate the raising of the arm [13,14,15]
The analysis of postoperative scores showed that there was no significant difference between the two groups (MD = 3.88) (Figure 2)
Summary
Other surgeons argue that reinserting the SSc limits external rotation and abduction and is biomechanically adverse for deltoid function, as the SSc functions as an adductor in the RSA, necessitating the deltoid function to facilitate the raising of the arm [13,14,15]. The external rotation has a major impact on the functioning of the arm as one goes about their daily chores and activities. Delaying this function, even if temporarily, may adversely affect the patient’s quality of life, especially for the elderly patients. A recent meta-analysis [18] on the role of the SSc reinsertion on the postoperative dislocation rate confirmed its protective function but did not show any difference between lateralized or medialized designs. We hypothesized that the reinsertion of the SSc when a lateralized design was used is biomechanically unfavorable in terms of its clinical and functional outcomes
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