subscapularis-sparingapproach for reverse total shoulder arthroplasty
Background: Standard surgical approaches for reverse total shoulder arthroplasty (RTSA), including deltopectoral and superolateral techniques, typically necessitate subscapularis tenotomy or deltoid muscle dissection. These maneuvers are associated with specific morbidities, such as postoperative instability, subscapularis insufficiency, and potential axillary nerve injury. While subscapularis-sparing techniques are established for anatomic shoulder arthroplasty, their application in RTSA remains less frequent despite the theoretical benefits regarding joint stability and accelerated functional recovery.
Objective: This article details a surgical technique for RTSA that preserves the integrity of both the subscapularis and deltoid muscles and evaluates the preliminary clinical outcomes and complications associated with this approach.
Key Points: The procedure utilizes a deltopectoral portal and accesses the glenohumeral joint through the rotator interval. Exposure is achieved via humeral extension and adduction, followed by a freehand humeral head osteotomy and glenoid preparation using specialized retractors. In a cohort of 65 patients, the mean Constant score improved from 45.6 ± 14.5 preoperatively to 74.7 ± 14.8 at one-year follow-up. The complication rate was 12%, including three tuberosity avulsion fractures and one transient axillary nerve palsy. No postoperative dislocations or infections were recorded. This approach facilitates immediate active mobilization without postoperative immobilization. However, the technique presents challenges due to restricted surgical exposure, which may increase technical difficulty in patients with significant joint stiffness or small anatomical proportions.
Conclusion: A subscapularis- and deltoid-sparing approach for RTSA is a viable alternative to traditional techniques. It facilitates early rehabilitation, reduces hospitalization duration, and maintains joint stability. While technically demanding, the approach demonstrates favorable short-term functional outcomes and a low complication profile.
