title: Anterior stability of the reverse shoulder arthroplasty depending on implant configuration and rotator cuff condition.
abstract: BACKGROUND
  The aim of this study was to investigate the stabilizing influence of the rotator cuff as well as the importance of glenosphere and onlay configuration on the anterior stability of the reverse total shoulder replacement (RTSR).
  
  
  METHODS
  A reverse total shoulder replacement was implanted into eight human cadaveric shoulders, and biomechanical testing was performed under three conditions: after implantation of the RTSR, after additional dissection of the subscapularis tendon, and after additional dissection of the infraspinatus and teres minor tendon. Testing was performed in 30° of abduction and three rotational positions: 30° internal rotation, neutral rotation, and 30° external rotation. Furthermore, the 38-mm and 42-mm glenospheres were tested in combination with a standard and a high-mobility humeral onlay. A gradually increased force was applied to the glenohumeral joint in anterior direction until the RTSR dislocated.
  
  
  RESULTS
  The 42-mm glenosphere showed superior stability compared with the 38-mm glenosphere. The standard humeral onlay required significantly higher anterior dislocation forces than the more shallow high-mobility onlay. External rotation was the most stable position. Furthermore, isolated detachment of the subscapularis and combined dissection of the infraspinatus, teres minor, and subscapularis tendon increased anterior instability.
  
  
  CONCLUSIONS
  This study showed superior stability with the 42-mm glenosphere and the more conforming standard onlay. External rotation was the most stable position. Detachment of the subscapularis as well as dissection of the complete rotator cuff decreased anterior stability.
authors: Department of Orthopedic Surgery, Medical School Hannover, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany.
authors: Marc-Frederic
authors: MF
authors: Pastor
authors: Laboratory of Biomechanics and Biomaterials, Medical School Hannover, Anna-von Borries-Str. 1-7, 30625, Hannover, Germany.
authors: Manuel
authors: M
authors: Kraemer
authors: Department of Orthopedic Surgery, Medical School Hannover, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany.
authors: Mathias
authors: M
authors: Wellmann
authors: Laboratory of Biomechanics and Biomaterials, Medical School Hannover, Anna-von Borries-Str. 1-7, 30625, Hannover, Germany.
authors: Christof
authors: C
authors: Hurschler
authors: Department of Orthopedic Surgery, Medical School Hannover, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany. tomas.smith@diakovere.de.
authors: Tomas
authors: T
authors: Smith
mesh_terms: D000072228:Arthroplasty, Replacement, Shoulder / Q000379:methods*; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D012399:Rotation; D017006:Rotator Cuff / Q000503:physiopathology*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*
keywords: Biomechanics; Dislocation; Instability; Reverse total shoulder arthroplasty; Rotator cuff tear