Scapular Notching Research Articles

Morphometric study of the suprascapular notch and scapular dimensions in adult Malawian cadavers and implications of completely ossified superior transverse scapular ligament.

Introductionthe anatomy of the suprascapular notch and its relationship to scapular dimensions are critical in the management of suprascapular neuropathies. Individuals show considerable differences in the dimensions of the suprascapular notch across populations. The purpose of this study was to determine the morphology and morphometric dimensions of the suprascapular notch in adult Malawian cadavers and to suggest clinical implications associated with complete ossification of the suprascapular ligament.Methodsadult dry scapulae from undetermined sex specimens (n=125) obtained from the skeletal collection at Kamuzu University of Health Sciences were classified according to the Rengachary categorization method to assess the suprascapular notch superior transverse distance, mid transverse distance, depth, scapula length and width using a standard Vernier caliper.Resultsthe most prevalent suprascapular notch class was type I, which was found in 46 (36.8%) of all scapulae. Type VI was the least common, found in only 1 (0.8%) of the scapulae. The mean notch superior transverse distance was 1.3 ± 0.6 cm, while the mean maximum depth was 0.6 ± 0.3 cm. Only the differences in depth, however, were statistically significant (p=0.001).Conclusionthe current study has described the morphology and morphometry of the suprascapular notch in relation to the risk of suprascapular nerve entrapment associated with complete ossification of the suprascapular ligament. Our sample population generally showed smaller suprascapular notch and scapular dimensions than other populations. This should be considered during the management of suprascapular neuropathy and preoperative planning of surgical operations of the shoulder region.

Translated article] Scapular notching in reverse shoulder arthroplasty. Relationship with surgeon's experience and clinical outcomes

BackgroundScapular Notching is a problem frequently seen in Reverse shoulder arthroplasties (RSAs), produced by a collision between the humeral component and the scapula. The main objective of this study is to analyze whether this problem decreases with the surgeons experience. As secondary objectives, assessing whether there is a relationship between its appearance and the clinical and functional outcome of patients. MethodsWe retrospectively reviewed 101 patients with 105 RSAs; we analyzed complications, focusing on scapular notching. Main follow-up time was 36 month (12–72). The clinical and functional outcomes were evaluated with the Constant scale and the QuickDash questionnaire. ResultsForty-two patients (40%) had some degree of scapular notching. Of these, 25 patients had grade I, 14 had grade II and 3 had grade III notching. The average postoperative Constant score for the entire series was 60.72. A tendency toward a reduced incidence of notching was observed with increasing numbers of operated cases and experience of the surgeon (p = 0.04). In the group of patients who had notching, the average postoperative Constant score was 56, and in the group that developed notching, the average score was 63. Patients with notching had significantly lower pain scores (p = 0.012). ConclusionsScapular notching is a common problem of RSA. In RSA, the experience of the surgeon reduces the appearance of problems and complications. Scapular notching is related to poorer clinical outcomes with respect to pain.

Effects of obesity on clinical and functional outcomes following anatomic and reverse total shoulder arthroplasty.

Limited data exist regarding the clinical and functional outcomes following primary total shoulder arthroplasty in obese patients. The purpose of this study is to determine the effects of obesity on the clinical and functional outcomes following primaryanatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) in a large patient population with mid-term follow-up. Patients in a multi-institutional shoulder registry receiving either primary aTSA (n = 1520) or rTSA (n = 2054) from 2004 to 2018 with a minimum follow-up period of 2 years were studied. All patients received the same single-platform shoulder prosthesis. Study groups were assigned based on implant type (anatomic or reverse), and further stratification was based on patient body mass index (BMI), with obese patients having a BMI ≥ 30 and non-obese patients having a BMI < 30. Patients were evaluated and scored preoperatively and at latest follow-up by use of 5 scoring metrics and range of motion (ROM). The mean follow-up period was 5 years (range, 2-14 years). Obese patients comprised 41% of the aTSA group and 35% of the rTSA group. Significant postoperative improvements in visual analog scale pain scores, ROM, and all 5 scoring metrics occurred in both obese and non-obese patients (P < .05). Obese patients in both groups reported higher preoperative and postoperative visual analog scale pain scores and less preoperative and postoperative ROM compared with non-obese patients. Compared with non-obese patients, obese patients receiving aTSA reported significantly worse postoperative Simple Shoulder Test, Constant-Murley, American Shoulder and Elbow Surgeons, University of California, Los Angeles, and Shoulder Pain and Disability Index scores compared with non-obese patients, and those receiving rTSA reported significantly worse American Shoulder and Elbow Surgeons and Shoulder Pain and Disability Index scores (all P < .05). However, these differences did not exceed the minimal clinically important difference or substantial clinical benefit criteria. Radiographic analysis showed that in the rTSA group, obese patients had significantly less postoperative scapular notching and a lower scapular notching grade compared with non-obese patients (P < .05). Both non-obese and obese patients can expect clinically significant improvements in pain, motion, and functional outcome scores following both aTSA and rTSA. Obese patients reported significantly more postoperative pain, lower outcome scores, and less ROM compared with non-obese patients after both aTSA and rTSA at a mean follow-up of 5 years. However, statistically significant differences were not found to be clinically significant with respect to established minimal clinically important difference and substantial clinical benefit criteria. Therefore, obese and non-obese patients experience similar clinical outcomes following total shoulder arthroplasty, regardless of BMI. However, obese patients have more comorbidities, greater intraoperative blood loss, and less scapular notching compared with non-obese patients.

Influence of scapular neck length on the extent of impingement-free adduction after reverse total shoulder arthroplasty.

Following reverse total shoulder arthroplasty, a short scapular neck length (SNL) decreases postoperative impingement-free adduction, and impingement between the neck of the scapula and the humeral polyethylene cup may cause scapular notching. However, no reports have evaluated the influence of SNL on impingement-free adduction. The purposes of this study were to evaluate the influence of SNL on impingement-free adduction and to examine the effect of glenoid component lateralization and inferiorization on impingement-free adduction. By use of 3-dimensional templating software, a virtual reverse total shoulder arthroplasty model was created in 15 patients who had no osteoarthritic change or any other bony deformity. We measured SNLs separately before implant placement (preoperative SNL) and after implant placement (postoperative SNL). The implant used was the Comprehensive Reverse Shoulder System (Zimmer Biomet, Warsaw, IN, USA), and baseplate bony lateralization of 0, 5, and 10 mm, with inferior eccentricity of 0.5 or 4.5 mm, was tested for impingement-free adduction. Correlations between the preoperative and postoperative SNLs and impingement-free adduction were analyzed. The mean preoperative SNL was 8.2 ± 1.9 mm (range, 5.0-11.7 mm), and the mean postoperative SNL was 6.0 ± 2.0 mm (range, 2.1-9.8 mm). There was a moderate correlation between the preoperative SNL and impingement-free adduction (r = 0.628, P = .12) and a strong correlation between the postoperative SNL and impingement-free adduction (r = 0.771, P = .001). Use of the model with 10 mm of bony lateralization and 4.5 mm of inferior eccentricity provided the best results in terms of impingement-free adduction. There were correlations between both the preoperative and postoperative SNLs and impingement-free adduction. Although the lateralized and inferiorized center of rotation may increase the risk of loosening of the glenoid component, this offset significantly increased impingement-free adduction.

Comparison of Clinical Performance of Inlay versus Onlay Humerus Implants in Reverse Total Shoulder Arthroplasty.

Reverse total shoulder arthroplasty (RTSA) has become the treatment of choice for the management of massive rotator cuff tears combined with cuff tear arthropathy, and many novel designs have been proposed to overcome the shortcomings of classic RTSA. This study sought to evaluate and compare RTSA outcomes among patients with cuff tear arthropathy treated by a medialized inlay humerus implant with a neck shaft angle of 155° or a lateralized onlay implant with a neck shaft angle of 145°. A retrospective review of 32 inlay implants and 32 onlay implants was performed. The active range of motion (ROM), visual analog scale (VAS) for pain, motor power for elevation and external rotation, and functional scores including the American Shoulder and Elbow Surgeons score, Constant score, and Korean Shoulder Scoring system were assessed before surgery, at 3, 6, and 12 months after surgery, and at the last follow-up at least 24 months after surgery. Scapular notching, lateral humeral offset, and deltoid wrapping offset were assessed for radiographic evaluation. The preoperative demographic data of both groups showed no significant differences (p > 0.05). The mean follow-up period was 24.9 months. Significant improvements in forward flexion, functional scores, and pain VAS score were observed in both groups at the last follow-up. No significant differences in ROM or functional scores were found between two groups at each time point, except that the onlay implant group exhibited a significantly greater range of external rotation at 3 and 12 months after surgery and at the last follow-up. The rate of scapular notching and the final power improvement did not show significant differences between the groups. Primary RTSA using inlay or onlay humerus implants was associated with recovery from pseudoparalysis and good clinical outcomes. However, RTSA with onlay humerus implantation led to clinically superior results in terms of external rotation.

Comparison of Lateralized Versus Medialized Reverse Total Shoulder Arthroplasty: A Systematic Review and Meta-analysis.

Background:Reverse total shoulder arthroplasty (rTSA) is an established procedure for cuff tear arthropathy. More lateralized prostheses have been designed to overcome the reported adverse outcomes of Grammont-style rTSA.Purpose:To compare the clinical and radiological outcomes of medialized and lateralized center of rotation (COR) in rTSA.Study Design:Systematic review; Level of evidence, 3.Methods:This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were studies with a level of evidence ≥3 that compared medialized and lateralized rTSA with a minimum follow-up of 12 months. Functional scores including the American Shoulder and Elbow Surgeons (ASES) score and Constant score (CSS), range of motion at final follow-up, gain of external rotation (ER), visual analog scale (VAS) pain score, scapular notching, and heterotopic ossification (HO) were compared. Data were analyzed using random-effects or fixed-effects models in accordance with heterogeneity.Results:Five retrospective cohort studies and 1 randomized controlled study (n = 594 patients) were included. Lateralized rTSA resulted in greater improvement in ER degree (P < .001), a lower VAS pain score (standardized mean difference [SMD], –0.39; P = .002), and a lower rate of scapular notching (risk ratio [RR], 0.40; P < .001) and HO (RR, 0.52; P < .001). Final forward flexion (SMD, –0.14; P = .629) and ER (SMD, 0.21; P = .238) did not differ significantly between the 2 groups. Overall functional scores, including ASES score (SMD, 0.22; P = .310) and CSS (SMD, 0.37; P = .077), also did not differ significantly (SMD, 0.28; P = .062). The overall complication rate did not differ significantly between the 2 groups (RR, 0.71; P = .339).Conclusion:Compared with medialized rTSA, lateralized COR rTSA results in greater improvement in ER and the VAS pain score, decreased rates of scapular notching and HO, and no significant changes in functional outcome scores or the complication rate.

Commentary to "Morphometry and Contents of the Suprascapular Notch with Potential Clinical Implications: A Cadaveric Study".

Commentary to "Morphometry and Contents of the Suprascapular Notch with Potential Clinical Implications: A Cadaveric Study".

Influence of the glenoid baseplate position on the direction and length of the superior and inferior locking screws.

Introduction : Superior screw insertion in reverse shoulder arthroplasty (RSA) carries the potential risk of suprascapular injury. The purpose of this study was to evaluate how the baseplate position affects the superior screw position and length in RSA. Methods : Three-dimensional (3D) computer simulation models of RSA were established using computed tomography data of baseplates with superior and inferior screws and 3D scapular models from 10 fresh cadavers. Superior screw position, the distance from the superior screw hole to the suprascapular notch, and the screw lengths were measured and compared among various baseplate positions with two inferior tilts (0 and 10 degrees) and three rotational patterns (11-5, 12-6, and 1-7 o'clock in the right shoulder). Results : For the 1-7 o'clock / inferior tilt 0 degrees baseplate, the superior screw located anterior to the SS notch in all shoulders, the distance to the SS notch was the longest (12.8 mm), and the inferior screw length was the shortest (23.1 mm). Conclusion : Although there is a concern of a short inferior screw length, initial fixation using a baseplate with 1-7 o'clock rotation and an inferior tilt of 0 degrees appears preferable for SS nerve injury prevention during superior screw insertion. J. Med. Invest. 69 : 185-190, August, 2022.

Surgical treatment of scapula body fractures extending glenoid fossa: Surgical technique and early results.

The aim of this study was to describe the surgical technique and evaluate functional outcomes following open reduction and internal fixation in patients with scapular fractures. In this study, ten patients with scapular fractures with Ideberg type four and five, who had undergone operatively with the Judet approach in three different orthopedic centers between March 2014 and October 2018, were evaluated retrospectively. By the end of at least a 2-year follow-up period, postoperative Disabilities of the Arm, Shoulder and Hand (DASH), Constant questionnaires were evaluated by all participating patients. Three of these patients had fractures on the left; seven patients had fractures on the right side, and the average patient age was 35.1±9.75. Mean Constant and DASH scores were 87.9±13.68 and 5.57±5.21, respectively. In two patients, about 2 cm adjacent to the suprascapular notch, perioperative suprascapular nerve injury was stated and sutured using the epineural technique. By the end of the 2-year follow-up of these two patients, infraspinatus muscle atrophy had occurred. However, external rotation muscle strength was 4/5 in both patients. This study suggests that scapula fractures extending glenoid articular surface can be safely fixed through the Judet approach and had satisfactory results. In addition, two patients with traumatic suprascapular nerve injury were encountered during the surgery and repaired which may be hard to diagnose with modified or minimal incisional approaches.

Evaluation of scapular notch after reverse shoulder arthroplasty. A cadaveric study

Evaluation of scapular notch after reverse shoulder arthroplasty. A cadaveric study

Morphology and morphometric study of dry scapula, with emphasis on the glenoid fossa and acromion process in Chennai city, South India

Background: The morphology and morphometry of the scapula and its glenoid fossa and acromion process play a significant role in the mechanics of shoulder joint. A variable morphology is found in glenoid fossa that has clinical implications. Aims and Objectives: The aim of the study was to evaluate the morphology and morphometry of dry scapula with emphasis on glenoid fossa and acromion process. Materials and Methods: A cross-sectional study was conducted at the department of anatomy, for a period of 6 months from January 2021 to June 2021. A total of 100 unpaired dry scapula were included in the study. The morphology and dimensions were measured. The dimensions were summarized as mean and standard deviation. Statistical analysis was done Chi-square test and student’s t-test based on the variable types. Results: Out of 100 scapulae studied, 48 were right sided and 52 were left sided. The mean of maximum length of the right scapula was 149.58±10.33 mm and the left side was 148.63±10.33 mm. Among the glenoid cavities, 54 were inverted comma shaped, 30 were pear shaped, and 16 were oval shaped. In one right-sided scapula Bony Spur Extends from Base of coracoid process to supra Scapular Notch. Conclusion: Size and shape of the glenoid cavity are directly related to the dislocation of shoulder joint and may affect the results of total shoulder arthroplasty and rotator cuff surgeries. The present study analyzed the morphological types and diameters of the glenoid cavity in adult scapulae to improve the efficacy and minimize the failure rates in shoulder arthroplasty particularly those involving the glenoid component of the shoulder joint.

Does correction of reverse shoulder arthroplasty angle improve clinical outcomes in cuff tear arthropathy?

The aim of this study was to investigate the impact of correction of the reverse shoulder arthroplasty (RSA) angle on clinical outcomes in patients with cuff tear arthropathy (CTA). This single-center retrospective study was conducted in patients with CTA treated with RSA between 2013 and 2018. A structured questionnaire collecting demographic data, postoperative follow-up time, pre- and postoperative range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) and Constant functional scores as well as scapular notching according to the Sirveaux Classification and RSA angle were evaluated by independent observers. The association between functional outcomes and RSA angle was analyzed using a curve estimation approach. Seventy-four patients with a mean age of 69.4 ± 8 years and mean follow-up period of 38.2 ± 10.8 months were included the study. The medialized inlay component was implanted in 35 patients, and the lateralized onlay component was used in 39 patients. The mean preoperative ASES and Constant scores improved from 28.4 ± 5.1 and 31.1 ± 5.9 to 73.4 ± 23.3 and 70.5 ± 16, respectively, at the last follow-up (both P < 0.001). The mean pre- and postoperative RSA angles were measured to be 21.3 ± 9.3° and 5.5 ± 10.1°, respectively, on X-ray. The postoperative RSA angle was 10.4 ± 10.3° in computerized tomography (CT) scans. There was an excellent correlation between X-ray and CT measurements (rs: 0.971, P < 0.001). It was found that patients with good postoperative functional scores tended to have an RSA angle of 0-10° postoperatively. The delta internal rotation of the medialized design group was greater than that of the lateralized design group (P = 0.029). In patients undergoing RSA for CTA, satisfactory clinical outcomes can be obtained by achieving a postoperative RSA angle of 0-10° with an asymmetrical inferior reaming technique. Level III, Therapeutic Study.

Onlay versus inlay humeral components in reverse shoulder arthroplasty: A systematic review and meta-analysis.

Advances have been made to the traditional inlay Grammont Reverse Shoulder Arthroplasty (RSA) design such as the onlay humeral component prosthesis. Currently, there is no agreement in the literature regarding the best option for the humeral component when comparing inlay and onlay designs. This review compares the outcomes and complications between onlay versus inlay humeral components for RSA. A literature search was conducted using PubMed and Embase. Only studies reporting outcomes comparing onlay versus inlay RSA humeral components were included. Four studies with 298 patients (306 shoulders) were included. Onlay humeral components were associated with better external rotation (ER) (p < 0.0001). No significant difference in forward flexion (FF) or abduction was found. Constant scores (CS) and VAS scores did not differ. Increased scapular notching was found in the inlay group (23.18%) versus the onlay group (7.74%) (p = 0.02). Postoperative scapular fractures and acromial fractures did not differ. Onlay and inlay RSA designs are associated with improved postoperative range of motion (ROM). Onlay humeral designs may be associated with greater ER and lower rate of scapular notching; however, no difference was found in Constant and VAS scores, so further studies are required to assess the clinical significance of these differences.

The Unidentified Skeletal Collection of Capuchos Cemetery (Santarém) housed at the University of Coimbra

The aim of this article is to present to the scientific and academic community the Unidentified Skeletal Collection of the Capuchos Cemetery. The skeletons, of contemporary individuals, were collected from the same cemetery as those of the 21st Century Identified Skeletal Collection, but their identification is unknown. The collection is composed of 73 individuals, of which 68 are adults of both sexes (34 females, 33 males, and one individual of unknown sex) and five are non-adults. The skeletons are reasonably preserved although several are incomplete as result of taphonomic changes during inhumations, but also due to the experimental research made so far. Most of the adult individuals present nonmetric characters, being the scapular notch the most frequent. Regarding the osteopathology, it was observed that the majority of adult individuals have pathological changes, with degenerative pathology being the most frequent. In addition, some individual exhibit medical devices and/or signs of chirurgical procedures.&#x0D; The Unidentified Skeletal Collection of the Capuchos Cemetery is an osteological collection that, although not containing individual biographical data, has contributed to teaching and research in Biological and Forensic Anthropology in subjects such as osteology, morphology, biological profile, paleopathology, cremains, and the development of new methods.

Medialized versus Lateralized Center of Rotation in Reverse Total Shoulder Arthroplasty: A Systematic Review and Meta-Analysis.

One of the original biomechanical principles of reverse total shoulder arthroplasty (RTSA) is medialization of the center of rotation (COR) relative to the native level of the glenoid. Several authors have proposed the lateralized center of rotation, which is characterized by a lateralized (L) glenoid and medialized (M) humeral component. The aim of this review is to compare the clinical and functional outcomes of COR in medialized (M-RTSA) and lateralized (L-RTSA) RTSA in patients with uniform indications and treatment through a meta-analysis. A PRISMA-guided literature search of PubMed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Cochrane Clinical Answers was conducted from April to May 2021. Twenty-four studies were included in the qualitative synthesis, and 19 studies were included in the meta-analysis. Treatment with RTSA resulted in positive post-operative outcomes and low complication rates for both groups. Statistically relevant differences between L-RTSA group and M-RTSA group were found in post-operative improvement in external rotation with arm-at-side (20.4° and 8.3°, respectively), scapular notching rates (6.6% and 47.7%) and post-operative infection rates (1% and 7.7%). Both lateralized and medialized designs were shown to improve the postoperative outcomes. Nevertheless, a lateralized COR resulted in greater post-operative external rotation.

Improved Clinical Outcomes After Lateralized Reverse Shoulder Arthroplasty: A Systematic Review.

Lateralized reverse shoulder arthroplasty (RSA) has emerged as an attempt to improve on some of the drawbacks of conventional RSA, such as glenoid notching and decrease in ROM. Although this new design is being used in clinical practice, the evidence is mostly limited to case series and has not been systematically reviewed. (1) How much did patient-reported outcome measures (PROMs) and ROM improve among patients who receive a lateralized RSA implant? (2) What proportion of shoulders experience complications, revision surgery, or scapular notching? The PubMed and EMBASE databases were searched from database inception to January 31, 2020. We included clinical studies that reported the PROMs and/or ROM of patients with insufficient rotator cuffs undergoing RSA with a lateralized implant. All other types of studies and those including patients with fractures, instability or escape, infection, rheumatologic disease, neurologic disease, or revision surgeries as an indication for RSA were excluded. PROMs and ROM were collected and are reported as mean values and ranges. Complications, revision surgery, and scapular notching are presented as proportions. The percentage of the mean change relative to the minimum clinically important difference (MCID) was calculated using the anchor-based value for each outcome. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. The initial search yielded 678 studies; 61 full-text articles were analyzed according to our eligibility criteria. After a detailed analysis, we included nine studies that evaluated 1670 patients (68% of whom [1130] were women) with a mean age of 71.8 ± 0.6 years. The mean follow-up period was 41.1 ± 5.6 months. The mean MINORS score was 12 ± 4. Active ROM improved for forward flexion (mean change 47° to 82°; MCID 12°), abduction (mean change 43° to 80°; MCID 7°), external rotation (mean change 8° to 39°; MCID 3°), and internal rotation (mean change -2 to 1 points). PROM scores also improved, including the American Shoulder and Elbow Surgeons score (mean change 20 to 50; MCID 20.9 points), Constant score (mean change 28 to 40; MCID 5.7 points), Simple Shoulder Test score (mean change 3 to 7; MCID 2.4 points), and VAS score (mean change -1.8 to -4.9; MCID -1.6 points). The proportion of shoulders with complications ranged from 0% (0 of 44) to 21% (30 of 140), and the proportion of shoulders with scapular notching ranged from 0% (0 of 76) to 29% (41 of 140). The proportion of patients undergoing revision ranged from 0% (0 of 44) to 13% (10 of 76) at short-term follow-up. Lateralized RSA is a reasonable alternative to medialized implants for patients with rotator cuff insufficiency because it might reduce the likelihood of scapular notching without apparently compromising PROMs or ROM. More studies are required to determine whether there is a direct correlation between the amount of lateralization and PROMs or ROM.

Associations between radiographic parameters in the reverse shoulder arthroplasty and patient outcomes.

Various radiological parameters have been measured in the Reverse Shoulder Arthroplasty (RSA) and correlated to patient outcomes, to determine best baseplate position. Results remain unclear with respect to certain parameters such as inferior baseplate tilt. We have investigated our series of patients to clarify the relationship between radiological parameters and patient outcomes. We conducted a UK based bi-centre retrospective review of 156 prostheses. Critical shoulder angle (CSA), RSA angle (RSAA), Overhang and Deltoid Lever Arm (DLA) were measured on preoperative and postoperative radiographs. Range of motion and Oxford Shoulder Score (OSS) (range 1-8 years) were obtained. We assessed for scapular notching at minimum 1 year follow up (n = 138). Decreased postoperative CSA and increased DLA were associated with higher OSSs (P = 0.001 and 0.019). Increased overhang and DLA were associated with increased flexion (P = 0.033 and 0.024 respectively). Multivariate analysis showed that CSA and DLA affected notching rate (P = 0.002 and 0.007). Baseplate tilt in relation to the acromion (CSA) and DLA are the most predictive parameters for notching and OSS. We recommend considering a maximum CSA of 26 degrees to decrease notching rate and improve OSS. We recommend considering an Overhang of at least 6 mm to improve FF.

Positioning of the metaglene in reverse shoulder arthroplasty: deltopectoral versus anterosuperior approach: a prospective randomized trial.

The primary objective of this study was to determine whether there are differences in metaglene positioning related to the approach used (deltopectoral vs. anterosuperior) in primary reverse shoulder prosthesis (reverse shoulder arthroplasty) implantation. The hypothesis was that there would be no differences in metaglene positioning between the 2 approaches. A prospective randomized trial was designed to evaluate metaglene positioning in primary reverse shoulder arthroplasty. The patients included were allocated to either the deltopectoral approach (group I) or the anterosuperior approach (group II). Glenosphere overhang and glenosphere tilt were assessed using the methods described by Lévigne etal, Simovitch etal, and Kempton etal, and the beta angle was assessed as described by Maurer etal. The functional outcome was assessed with the Constant score at 2 years' follow-up. Scapular notch development and complication rates were also recorded. A total of 98 patients (77 women and 21 men) were randomized and allocated to group I (49 patients) or group II (49 patients). The mean age of the patients was 74.4 years (standard deviation, 6.3 years). Glenosphere overhang did not show significant differences between groups (6.5 mm in group I vs. 6.1 mm in group II by the Lévigne method, P = .482; 2.2 mm in group I vs. 2.1 mm in group II by the Simovitch method, P = .08). Glenosphere tilt was significantly different between groups (94.6° in group I vs. 86.8° in group II by the Lévigne method, P < .001; 125.9° in group I vs. 119.4° in group II by the Kempton method, P = .002). This was also the case for the prosthesis-scapular neck angle (94.6° in group I vs. 86.8° in group II, P < .001). Moreover, the postoperative beta angle was significantly different between groups (78.6° in group I vs. 73.8° in group II, P = .001). No significant differences were noted in terms of functional outcomes as measured with the Constant score (P = .16). No significant differences between groups were noted relative to scapular notch development and the overall complication rate. The deltopectoral and anterosuperior approaches do not differ relative to the craniocaudal positioning of the metaglene, but a slight superior tilt can be expected when using the anterosuperior approach. Both approaches yield comparable functional outcomes, scapular notch development, and complication rates at 2 years' follow-up.

Reverse Shoulder Arthroplasty Humeral Lateralisation: A Systematic Review.

Different studies on reverse shoulder arthroplasty (RSA) have proposed changes to the humeral design to lateralise the humeral centre of rotation (COR), with humeral inclination to 135 or 145 from 155 degrees or to switch to onlay humeral trays from inlay design; with both having also been used in combination. There have been many studies and systematic reviews to show the difference in outcomes and complications to the variations in glenoid design but to date, there have been no systematic studies to compare different humeral inclinations for RSA implants.Searches using keywords were used in common medical search engines in a systematic fashion. The article was reviewed for the class of evidence and bias, summarised and compared in meta-analysis. Inclusion criteria included studies on adults with RSA that compared lateralised humeral implants to medialised.The search produced 349 articles; of these, we identified nine studies that met the inclusion criteria. Our review identified a total of 562 patients who had been included in studies directly comparing lateralised humerus to a more medial design. Meta-analysis showed a significantly reduced risk of scapular notching in lateralised humerus compared to the standard medialised component. The external rotation range of motion in the lateralised group was statistically significant.The improvement in scapular notching and gain in the range of motion without any apparent downside in the form of reduced patient-reported outcome measures or complications suggest a lateralised humeral component is superior to the more medialised design in RSA. A large RCT with a longer-term follow-up is needed to confirm whether there is clinically significant benefit from the lateralisation of the humerus.

Reverse Shoulder Arthroplasty After Prior Rotator Cuff Repair: A Matched Cohort Analysis.

Rotator cuff repair (RCR) is commonly performed before reverse shoulder arthroplasty (RSA) with conflicting evidence on the effect on arthroplasty outcomes. The purpose of this investigation was to evaluate the effect of a prior RCR on the outcomes and complications of primary RSA. Between 2007 and 2017, 438 RSAs performed in patients with a prior RCR and 876 case-matched controls were identified from a multicenter database. Patients were grouped based on a preoperative diagnosis of glenohumeral osteoarthritis (GHOA) and rotator cuff tear arthropathy (CTA). Data collected included range of motion, strength, complications, and revisions. Additional clinical metrics included American Shoulder and Elbow Society score, Constant score, Shoulder Pain and Disability Index, Simple Shoulder Test, and the University of California Los Angeles shoulder score. Compared with controls, both GHOA and CTA study groups demonstrated lower postoperative forward elevation (FE) (133° versus 147°, P < 0.001; 133° versus 139°, P = 0.048) and FE trength (6.5 versus 8.2, P = 0.004; 6.1 versus 7.3, P = 0.014). In addition, inferior improvements were observed in the GHOA and CTA study groups with respect to abduction (38° versus 52°, P = 0.001; 36° versus 49°, P = 0.001), FE (41° versus 60°, P < 0.001; 38° versus 52°, P = 0.001), ER (16° versus 25°, P < 0.001; 10° versus 17°, P = 0.001), and Constant score (28.4 versus 37.1, P < 0.001; 26.2 versus 30.9, P = 0.016). Compared with controls, no differences were observed in the GHOA and CTA study groups with respect to notching (11.2% versus 5.6%, P = 0.115; 5.8% versus 7.9%, P = 0.967), complications (4.3% versus 1.6%, P = 0.073; 2.5% versus 2.7%, P = 0.878), and revision surgery (3.1% versus 0.9%, P = 0.089; 1.1% versus 1.3%, P = 0.822). RSA after a prior RCR improves both pain and function, without increasing scapular notching, complications, or revision surgery. However, compared with patients without a prior RCR, postoperative shoulder function may be slightly decreased. III; Retrospective Cohort Study.