Retaining or excising the supraspinatus tendon in complex proximal humeral fractures treated with reverse prosthesis: a biomechanical analysis in two different designs
We aimed to biomechanically evaluate the effect of the supraspinatus tendon on tuberosity stability using two different reverse shoulder arthroplasty (RSA) models for complex proximal humeral fractures (PHFs).
Four-part proximal humeral fractures were simulated in 20 cadaveric shoulders. Two different RSA designs were implemented: a glenosphere-medialized model and a glenosphere-lateralized model. Tuberosities were reconstructed, and displacement of bony fragments was measured (mm) by placing three sensors: in the humeral diaphysis (D), in the greater tuberosity (GT), and in the lesser tuberosity (LT). Axial forces were induced and measured in Newton (N). The test was performed twice in each specimen, with and without the supraspinatus tendon. The regression line (RL) was measured in mm/N.
In the medialized model, the GT–D displacement was greater in the supraspinatus preserving model than that in the tendon excision model (p < 0.001), as well as for the LT–D displacement (p < 0.001). In the lateralized model, GT–D displacement and GT–LT distance were greater in the preserving model than that in the excision model (p < 0.001, p = 0.04).
The supraspinatus tendon resection leads to a more biomechanically stable tuberosity construct when performing RSA for PHFs, while the rest of the rotator cuff tendons (infraspinatus and teres minor) are retained in the greater tuberosity.
Level of evidence
Basic science study. Cadaveric study.
KeywordsTuberosity reconstruction Reverse shoulder arthroplasty Supraspinatus Cadaveric study Rotator cuff excision Complex proximal humeral fractures
Compliance with ethical standards
Conflict of Interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 1.Acevedo DC, Mann T, Abboud JA, Getz C, Baumhauer JF, Voloshin I (2014) Reverse total shoulder arthroplasty for the treatment of proximal humeral fractures: patterns of use among newly trained orthopedic surgeons. J Shoulder Elbow Surg 23:1363–1367. https://doi.org/10.1016/j.jse.2014.01.005 CrossRefPubMedGoogle Scholar
- 2.Bufquin T, Hersan A, Hubert L, Massin P (2007) Reverse shoulder arthroplasty for the treatment of three-and four-part fractures of the proximal humerus in the elderly a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg [Br] 89:516–520. https://doi.org/10.1302/0301-620X.89B4.18435 CrossRefGoogle Scholar
- 3.Sebastiá-Forcada E, Cebrián-Gomez R, Lizaur-Utrilla A, Gil-Guillen V (2014) Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elbow 23:1419–1426. https://doi.org/10.1016/j.jse.2014.06.035 CrossRefGoogle Scholar
- 5.Grammont PM, Trouilloud P, Laffay JPDX (1987) Etude et realisation d’une novelle prothese d’epaule. Rhumatologie 39:17–22Google Scholar
- 13.Uzer G, Yildiz F, Batar S, Binlaksar R, Elmadag M, Kus G, Bilsel K (2017) Does grafting of the tuberosities improve the functional outcomes of proximal humeral fractures treated with reverse shoulder arthroplasty? J Shoulder Elbow Surg 26:36–41. https://doi.org/10.1016/j.jse.2016.05.005 CrossRefPubMedGoogle Scholar
- 16.Frankle MA, Greenwald DP, Markee BA, Ondrovic LE, Lee WE (2001) Biomechanical effects of malposition of tuberosity fragments on the humeral prosthetic reconstruction for four-part proximal humerus fractures. J Shoulder Elbow Surg 10:321–326. https://doi.org/10.1067/mse.2001.113962 CrossRefPubMedGoogle Scholar
- 18.Chaffin DB, Andersson GBJ, Martin BJ (1999) Occupational biomechanics. Wiley, New YorkGoogle Scholar