Massive irreparable rotator cuff tear and associated deltoid tear. Does the reverse shoulder arthroplasty and deltoid repair be a possible option of treatment?

Background and purpose: Rupture of the anterior and middle deltoid muscle associated with rotator cuff tear arthropathy (RCA) could result in a definitive loss of shoulder function. The purpose of this study was to evaluate clinical outcomes after a concomitant reverse shoulder arthroplasty (RSA) and deltoid repair under these circumstances. Materials and methods: Between 2006 and 2012, 18 consecutive patients with a mean age of 69.7 years, affected by massive irreparable rotator cuff tear and associated dehiscence or rupture of anterior and middle deltoid muscle underwent this operation through a modified anterosuperior approach. Four patients referred a previous shoulder surgery and deltoid tear was iatrogenic. The other 14 cases had an attritional deltoid tears. The average follow-up was 64 months (range 25-121 months). Results: The mean active anterior elevation passed from a preoperative mean of 53 +/- 9.1 (range 45-70) to 132.7 +/- 11.6 degrees (85-155 degrees), active external rotation passed from a preoperative mean value of 22.4 +/- 3.6 degrees (range 18-26) to an average of 33.7 +/- 4.7 degrees (range 30-40 degrees). Mean Constant score increased from 42 +/- 6.1 (range 31-51) pre-operatively to 72.3 +/- 8.2 (range 57-82) post-operatively. At final review, deltoid contour subjectively was satisfactory to all patients with no palpable defects. Conclusion: RSA associated with a repair of deltoid tear could be a viable surgical option in cases of tear involving the anterior and middle deltoid associated with a RCA. Patient with a preoperative chronic axillary nerve neuropathy associated with a deltoid muscle tear should be cautioned about the possibility of lower functional outcomes. (C) 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.