Postoperative rupture of the anterolateral deltoid muscle following reverse total shoulder arthroplasty in patients who have undergone open rotator cuff repair

Background: Postoperative ruptures of the antero-lateral deltoid in patients with reverse total shoulder arthroplasty utilizing the delto-pectoral approach following failed mini-open or open rotator cuff repairs have not been reported in the English literature. The incidence of this complication is unknown. Materials and methods: A retrospective review of 199 patients who underwent reverse total shoulder arthroplasty utilizing a deltopectoral approach was performed. These procedures were performed by 2 surgeons in 2 hospitals. There were 3 patients who had postoperative rupture of the deltoid. These ruptures occurred without any history of trauma to the patient. In all 3 patients, past surgical history was significant for a rotator cuff repair utilizing a mini-open or mini-open modified to open approach. Successful repair of the deltoid was achieved using a transosseous suture repair in all 3 patients. Results: At most current follow-up (all >12 months), average forward elevation was 120 degrees. A small residual anterior deltoid defect was present in all 3 patients, but pain was quantified as 0-4 out of 10 and radiographs demonstrated satisfactory position of the reverse arthroplasty implants. Conclusion: Postoperative ruptures of the antero-lateral deltoid can occur in patients who have undergone reverse total shoulder arthroplasty, utilizing the delto-pectoral approach following failed mini-open or open rotator cuff repairs. A supero-lateral approach during reverse total shoulder arthroplasty could be useful in assessing and possibly reinforcing a deltoid origin previously damaged or repaired during mini-open or open rotator cuff repair. Level of evidence: Level IV, Case Series, Treatment Study. (C) 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.