Following reverse total shoulder arthroplasty (rTSA), recurrent shoulder instability is a complex clinical issue. Only after revision rTSA with cerclage augmentation stability has been documented in a few patients. As an adjunct to salvage shoulder stability, researchers presented an acromiohumeral cerclage approach. The humeral component was secured using nonabsorbable, high-tensile suture tape wrapped via transosseous acromial drill holes. Between November 1, 2015, and February 1, 2020, all patients treated with acromiohumeral cerclage in rTSA for instability with a minimum 1-year follow-up were included. The following data was collected and compared: demographics, baseline preoperative and postoperative range of motion at the most recent follow-up, American Shoulder and Elbow Surgeons (ASES) shoulder scores, and visual analog scale (VAS) scores.

The study included ten patients, four females, and six males, with an average age of 64.3 ± 7.4 years (range 53 to 77 years) and a mean postoperative follow-up of 23 months. About 90% of the patients had surgery on the dominant side. Before revision with suture cerclage augmentation, patients had an average of 2.1±1.9 prior revisions (range 0 to 7) over an average of 10.4 months (range 0 to 72 months). With an average of 0.6± 0.9 (range 0 to 3) before additional shoulder procedures were conducted before their initial rTSA, all patients had significant past shoulder histories at other institutions and co-morbidities that contributed considerable difficulty to their situations. The average reduction in VAS score among the ten patients was 4.3± 2.7 (p<0.05), with scores ranging from 0 to 8. The average increase in ASES score was 51.3± 21 points (p<0.05), with scores ranging from 13.3 to 69.9. For eight patients, the average increase in active forward elevation was 79°± 39° (p=0.0008), ranging from 40° to 160°. Since their final procedures, all patients have remained stable with well-positioned prostheses, with no recurring dislocations or acromial problems. Two patients who were unable to travel to the office for an appointment were reached by phone and asked questions to acquire their postoperative ASES and VAS scores. In revision, enlargement of the acromiohumeral cerclage suture In cases of recurrent, chronic instability, rTSA may be a beneficial, uncomplicated surgical procedure to combine with other repair and augmentation techniques, particularly in the case of many revisions.

 

Reference:www.jshoulderelbow.org/article/S1058-2746(22)00232-4/fulltext