Spontaneous Deltoid Tear in Cuff Tear Arthropathy and Its Effect on the Outcome of Reverse Total Shoulder Arthroplasty: A Comparison Using Propensity Score Matching

Kyung Jae Lee; Young Hoon Jang; Ji Hoon Nam; Hye Jin Yoo; Sae Hoon Kim

doi:10.4055/cios22343

Spontaneous Deltoid Tear in Cuff Tear Arthropathy and Its Effect on the Outcome of Reverse Total Shoulder Arthroplasty: A Comparison Using Propensity Score Matching

Clin Orthop Surg. 2023 Aug;15(4):627-636. doi: 10.4055/cios22343. Epub 2023 Jun 14.

Authors

Kyung Jae Lee¹, Young Hoon Jang², Ji Hoon Nam³, Hye Jin Yoo⁴, Sae Hoon Kim³

Affiliations

¹ Department of Orthopedic Surgery, Chung-Ang University Medical Center, Chung-Ang University School of Medicine, Seoul, Korea.
² Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Seoul, Korea.
³ Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
⁴ Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Abstract

Background: Deltoid function critically influences the results of reverse total shoulder arthroplasty (RTSA), and spontaneous deltoid attrition tears are frequently detected in cuff tear arthropathy (CTA) patients; however, the clinical impacts of these tears on RTSA outcomes are undetermined. Our aim was to determine the effect of spontaneous deltoid attrition tears on postoperative outcomes after RTSA without an additional deltoid procedure.

Methods: Seventy-two patients who underwent RTSA for CTA with preoperative magnetic resonance imaging (MRI) and a minimum clinical follow-up of 1 year (mean, 32 months) were retrospectively reviewed in the study. Patients with a history of previous shoulder surgery or injury were excluded. The presence and location of deltoid attrition tears were determined in preoperative MRI. Propensity score matching (1:1) was performed to construct tear and no-tear groups. Finally, 21 patients, matched with respect to age, sex, hand dominance, symptom duration, medical comorbidity (obesity, diabetes mellitus, and coronary artery disease), Hamada grade, and implant type, were assigned to each group. Clinical outcomes (functional scores, isometric power, and range of motion) in the two groups were compared.

Results: Deltoid attrition tears were detected in 21 of the 72 enrolled cases (29.1%). Anterolateral deltoid was the most frequent location and no tear was detected in the posterior deltoid. The tear rate increased with disease severity (Hamada G2, 4.8%; G3, 23.8%; > G4, 71.4%). No pre- or postoperative clinical variables differed significantly between the tear and no tear groups.

Conclusions: Deltoid attrition tears were detected in 29% of CTA patients who underwent RTSA. The most common site was the anterolateral region and tear prevalence tended to increase with CTA progression. However, RTSA was found to provide satisfactory outcomes regardless of the presence of a deltoid attrition tear.

Keywords: Clinical outcome; Cuff tear arthropathy; Deltoid attrition tear; Reverse total shoulder arthroplasty.

MeSH terms

Arthroplasty, Replacement, Shoulder* / methods
Humans
Propensity Score
Range of Motion, Articular
Retrospective Studies
Rotator Cuff Injuries* / diagnostic imaging
Rotator Cuff Injuries* / surgery
Rotator Cuff Tear Arthropathy* / surgery
Rupture / surgery
Shoulder Joint* / surgery
Treatment Outcome