Comparative analysis of the results of reverse shoulder arthroplasty using the deltopectoral approach with complete or partial subscapularis muscle dissection

Introduction . Indications for reverse shoulder arthroplasties (RSA) have increased since their development by Paul Grammont in 1985. The design of the endoprosthesis has been improved, significantly reducing the incidence of postoperative complications. However, the question of how to treat the subscapularis muscle (SSC muscle) during reverse shoulder arthroplasty remains open. The aim . To compare the functional and clinical outcomes in patients undergoing reverse shoulder arthroplasty performed via the deltopectoral approach with either complete or partial subscapularis muscle dissection. Materials and methods . A randomized clinical trial was conducted for evaluating the outcomes of reverse shoulder arthroplasty in 49 patients. The cohort was divided into two groups. In the first group, implantation of the reverse endoprosthesis was performed using the standard deltopectoral approach, whereas in the second group a novel surgical approach with partial subscapularis muscle dissection was employed. Clinical and functional outcomes were assessed postoperatively, and at 3 and 12 months of follow-up, using the American Shoulder and Elbow Surgeons (ASES) score and the Visual Analog Scale (VAS) for pain. Results . Patients who underwent a surgical approach with partial subscapularis muscle dissection, in the postoperative period, demonstrated better scores on the ASES scale, a greater degree of anterior flexion and less intensity of pain compared to the group of patients after standard deltopectoral approach. Conclusion . The surgical approach with partial subscapularis muscle dissection improves functional and clinical outcomes after reverse shoulder arthroplasty also it reduces the probability of joint dislocation.