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Subscapularis Repair Is Unnecessary After Lateralized Reverse Shoulder Arthroplasty

Roberson, Troy A., MD1; Shanley, Ellen, PT, PhD, OCS2; Griscom, James T., BS3; Granade, Michael, PharmD2; Hunt, Quinn, BS2; Adams, Kyle J., BS4; Momaya, Amit M., MD1; Kwapisz, Adam, MD4; Kissenberth, Michael J., MD1; Lonergan, Keith T., MD1; Tolan, Stefan J., MD1; Hawkins, Richard J., MD1; Tokish, John M., MDa,5

doi: 10.2106/JBJS.OA.17.00056
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Background: Controversy exists as to whether the subscapularis should be repaired after reverse shoulder arthroplasty. The purpose of the present study was to evaluate the utility of repairing the subscapularis after reverse shoulder arthroplasty with regard to complications, objective findings, and patient-reported outcome measures.

Methods: We retrospectively reviewed the records for 99 patients who had undergone a lateralized reverse shoulder arthroplasty with (n = 58) or without (n = 41) subscapularis repair. Outcomes were compared with the Single Assessment Numeric Evaluation (SANE), Penn shoulder score (PSS), Veterans RAND (VR)-12, and American Shoulder and Elbow Surgeons (ASES) score at a minimum of 2 years of follow-up. Demographics, range of motion, and complications were also compared. A 1-way analysis of variance was performed to determine differences in performance and outcome scores, and a chi-square analysis was performed to compare the frequency of complications between groups.

Results: There were no significant differences between the repair and no-repair groups in terms of SANE, PSS, ASES, or VR-12 scores. There also were no significant differences between the 2 groups in terms of postoperative ranges of forward elevation (128° versus 123°; p = 0.44) and external rotation (33° versus 29°; p = 0.29), the dislocation rate (5% versus 2%; p = 0.49), or the overall complication rate (9% versus 5%; p = 0.47).

Conclusions: The results of the present study suggest that repair of the subscapularis tendon after lateralized reverse shoulder arthroplasty may not be necessary.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

1Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina

2University of South Carolina School of Medicine, Greenville, South Carolina

3ATI Physical Therapy, Greenville, South Carolina

4Hawkins Foundation, Greenville, South Carolina

5Mayo Clinic Arizona, Phoenix, Arizona

E-mail address for J.M. Tokish: Tokish.john@mayo.edu

Investigation performed at Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina

Disclosure: There was no external funding source for this project. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJSOA/A51).

© 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Journal of Bone and Joint Surgery, Incorporated.