Rizzoli Sicilia Department, IRCCS Istituto Ortopedico Rizzoli, SS 113, km 246, 90011, Bagheria, PA, Italy.
SC Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
Arch Orthop Trauma Surg. 2022 Sep;142(9):2147-2156. doi: 10.1007/s00402-020-03716-9. Epub 2021 Feb 26.
Inadequate subscapularis repair has been advocated as one of the contributing factors for dislocation in reverse total shoulder arthroplasty; nonetheless the need to restore the subscapularis tendon integrity is under debate. The aim of this systematic review was to answer the question: does subscapularis reattachment following reverse total shoulder arthroplasty improve joint stability, range of motion and functional scores?
The literature was systematically screened in accordance with PRISMA guidelines looking for papers evaluating clinical outcomes of reverse total shoulder arthroplasty in relation to the management of subscapularis tendon. Studies comparing clinical outcomes, complications and dislocation rate with or without subscapularis repair were included. Studies in which reverse total shoulder arthroplasty was performed for trauma or tumors were excluded. The methodology of included articles was scored with MINORS scale and the Risk of Bias was assessed adopting the ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions) developed by the Cochrane Group. A meta-analysis was also performed combining the studies to increase the sample size and hence the power to obtain meaningful data.
The database search identified 1062 records, and 6 full-text articles were finally included. A total number of 1085 reverse total shoulder arthroplasty were assessed on. Except for one study, lateralized prosthetic designs have been used. Dislocation occurred in 0.8% (5/599 patients) of the patient with repaired subscapularis and in 1.6% (8/486 patients) of the tenotomized patients, and subscapularis repair was not associated with a higher risk of dislocation (pooled Peto OR: 0.496, 95% CI: 0.163 to 1.510, p = 0.217). Qualitative assessment revealed no differences in the range of motion and clinical scores.
Subscapularis repair after reverse total shoulder arthroplasty produces no clinically meaningful benefits, particularly using lateralized prosthetic designs. Subscapularis re-attachment does not improve implant stability, nor increases range of motion or clinical scores. Given these results, keeping in mind the antagonistic effect of the repaired subscapularis on external rotation, no evidence lead to suggest subscapularis reattachment following reverse total shoulder arthroplasty with lateralized prosthetic designs.
肩胛下肌修复不充分被认为是反式全肩关节置换术后脱位的一个影响因素；然而，修复肩胛下肌腱完整性的必要性仍存在争议。本系统评价旨在回答以下问题：反式全肩关节置换术后修复肩胛下肌能否改善关节稳定性、活动范围和功能评分？
根据 PRISMA 指南系统筛选文献，寻找评估反式全肩关节置换术与肩胛下肌腱处理相关的临床结果的论文。纳入比较肩胛下肌修复与不修复的临床结果、并发症和脱位率的研究。排除因创伤或肿瘤而行反式全肩关节置换术的研究。采用 MINORS 量表对纳入文章的方法学进行评分，并采用 Cochrane 组开发的 ROBINS-I（非随机干预研究的偏倚风险）评估偏倚风险。还进行了荟萃分析，以增加样本量，从而获得有意义的数据。
数据库检索共确定了 1062 条记录，最终纳入 6 篇全文文章。共评估了 1085 例反式全肩关节置换术。除了一项研究外，均使用了侧置假体设计。肩胛下肌修复组的脱位发生率为 0.8%（5/599 例），肩胛下肌切断组的脱位发生率为 1.6%（8/486 例），肩胛下肌修复与脱位风险增加无关（汇总 Peto OR：0.496，95%CI：0.163 至 1.510，p=0.217）。定性评估显示，活动范围和临床评分无差异。
反式全肩关节置换术后修复肩胛下肌没有产生有临床意义的益处，特别是使用侧置假体设计时。肩胛下肌再附着并不能提高植入物的稳定性，也不会增加活动范围或临床评分。鉴于这些结果，并考虑到修复后的肩胛下肌对外部旋转的拮抗作用，没有证据表明在使用侧置假体设计的反式全肩关节置换术后需要修复肩胛下肌。
