Supraspinatus Tenotomy in Reverse Shoulder Arthroplasty for Fractures: A Comparative Cohort Study

Background: The aim of this study was to evaluate the functional and radiographic outcome in patients with reverse total shoulder arthroplasty (RSA) for displaced proximal humeral fractures (PHF) with or without tenotomy of the supraspinatus tendon. Methods: Between June 2011 and June 2018, 159 patients (age >65 years) with a displaced proximal humeral fracture underwent reverse total shoulder arthroplasty (Grammont design) in a single-center study and were longitudinally followed up. In all cases, the tuberosities were attached to the prosthesis in a standardized procedure. Functional outcome, range of motion as well as tuberosity integration, resorption and displacement were assessed at final follow-up. Outcomes were compared between patients that underwent RSA in combination with tenotomy of the supraspinatus (ST) and patients that underwent RSA without supraspinatus tenotomy (NT). Results: At a mean follow up of 22.2 +/- 16.4 months 76 patients (mean age 77.1 +/- 7.2 years, 83% women) could be evaluated (follow-up rate 47.8%). There were no statistically significant differences between the ST (n = 29) and NT groups (n = 47) in tuberosity integration, resorption </>= 50%, or displacement (p = 0.99/0.31/0.7/0.99). Functional outcome was better in ST group (Constant score 76.2 +/- 5.9 vs. 64.5 +/- 12.8; p < 0.05) especially regarding mean active external rotation (>20 degrees: 65.5% vs. 14.9%, p < 0.05) and active abduction (>120 degrees: 89.7% vs. 21.3%, p < 0.05). Tuberosity integration (ST and NT together: n = 34) showed better functional results than resorption or displacement (p < 0.05). Conclusions: Tenotomy of the supraspinatus tendon in RSA for displaced PHF leads to similar radiographic results regarding tuberosity integration, resorption and displacement but better functional outcome with regard to range of motion.