Rotator cuff-sparing approaches for glenohumeral joint access: an anatomic feasibility study

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Title: Rotator cuff-sparing approaches for glenohumeral joint access: an anatomic feasibility study
Author(s): Amirthanayagam, TD
Amis, AA
Reilly, P
Emery, RJH
Item Type: Journal Article
Abstract: Background The deltopectoral approach for total shoulder arthroplasty can result in subscapularis dysfunction. In addition, glenoid wear is more prevalent posteriorly, a region difficult to access with this approach. We propose a posterior approach for access in total shoulder arthroplasty that uses the internervous interval between the infraspinatus and teres minor. This study compares this internervous posterior approach with other rotator cuff–sparing techniques, namely, the subscapularis-splitting and rotator interval approaches. Methods The 3 approaches were performed on 12 fresh frozen cadavers. The degree of circumferential access to the glenohumeral joint, the force exerted on the rotator cuff, the proximity of neurovascular structures, and the depth of the incisions were measured, and digital photographs of the approaches in different arm positions were analyzed. Results The posterior approach permits direct linear access to 60% of the humeral and 59% of the glenoid joint circumference compared with 39% and 42% for the subscapularis-splitting approach and 37% and 28% for the rotator interval approach. The mean force of retraction on the rotator cuff was 2.76 (standard deviation [SD], 1.10) N with the posterior approach, 2.72 (SD, 1.22) N with the rotator interval, and 4.75 (SD, 2.56) N with the subscapularis-splitting approach. From the digital photographs and depth measurements, the estimated volumetric access available for instrumentation during surgery was comparable for the 3 approaches. Conclusion The internervous posterior approach provides greater access to the shoulder joint while minimizing damage to the rotator cuff.
Publication Date: 10-Oct-2016
Date of Acceptance: 1-Oct-2016
URI: http://hdl.handle.net/10044/1/61131
DOI: https://dx.doi.org/10.1016/j.jse.2016.08.011
ISSN: 1058-2746
Publisher: Elsevier
Start Page: 512
End Page: 520
Journal / Book Title: Journal of Shoulder and Elbow Surgery
Volume: 26
Issue: 3
Copyright Statement: © 2016 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Science & Technology
Life Sciences & Biomedicine
Orthopedics
Sport Sciences
Surgery
Glenohumeral joint
cadaver
rotator cuff sparing
posterior approach
subscapularis split
rotator interval
total shoulder arthroplasty
shoulder resurfacing
TOTAL SHOULDER ARTHROPLASTY
SKELETAL-MUSCLE
AXILLARY NERVE
SUBSCAPULARIS
COMPLICATIONS
REPLACEMENT
SURGERY
HUMERUS
Glenohumeral joint
cadaver
posterior approach
rotator cuff sparing
rotator interval
shoulder resurfacing
subscapularis split
total shoulder arthroplasty
Aged
Aged, 80 and over
Arthroplasty, Replacement, Shoulder
Cadaver
Feasibility Studies
Female
Humans
Image Processing, Computer-Assisted
Male
Middle Aged
Minimally Invasive Surgical Procedures
Photography
Rotator Cuff
Shoulder Joint
Rotator Cuff
Shoulder Joint
Humans
Cadaver
Photography
Feasibility Studies
Image Processing, Computer-Assisted
Aged
Aged, 80 and over
Middle Aged
Female
Male
Minimally Invasive Surgical Procedures
Arthroplasty, Replacement, Shoulder
Science & Technology
Life Sciences & Biomedicine
Orthopedics
Sport Sciences
Surgery
Glenohumeral joint
cadaver
rotator cuff sparing
posterior approach
subscapularis split
rotator interval
total shoulder arthroplasty
shoulder resurfacing
TOTAL SHOULDER ARTHROPLASTY
SKELETAL-MUSCLE
AXILLARY NERVE
SUBSCAPULARIS
COMPLICATIONS
REPLACEMENT
SURGERY
HUMERUS
1103 Clinical Sciences
Orthopedics
Publication Status: Published
Appears in Collections:Faculty of Engineering
Mechanical Engineering
Bioengineering
Division of Surgery
Faculty of Medicine



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