JSES - 2026-06-01 - Journal Article; Multicenter Study
Postoperative scapular neck length is associated with strength and rotational range of motion following reverse total shoulder arthroplasty with the Arthrex Univers Revers.
Denard AD, Werner BC, Schuette HB, DeBruin AE, Shoulder 90 Arthroplasty Research Committee (ShARC) group, Sears BW
Topics
Key Takeaway
Postoperative medial glenosphere-to-lateral scapular column distance (MGLS) >10 mm yields 73° vs. 57° external rotation at 90° abduction and superior internal rotation (L3 vs. L4) compared to MGLS 5–10 mm after lateralized 135° rTSA.
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Summary
This multicenter retrospective study of a prospectively collected database examined whether postoperative scapular neck length (quantified as MGLS) influences ROM, strength, and PROs at 2 years after rTSA with the Arthrex Univers Revers (lateralized, 135° neck-shaft angle). MGLS >10 mm was independently associated with improved abduction strength (P=.011), belly press strength (P<.001), external rotation at 90° (73° vs. 57°; P=.013), and internal rotation to a higher spinal level (L3 vs. L4; P<.001) compared to lower MGLS strata. Preoperative SNL negatively correlated with external rotation strength (P=.039) but did not predict PROs, ROM, or scapular notching.
Key Limitation
The study is implant-specific to the Arthrex Univers Revers, and findings may not be generalizable to medialized or alternative-angle rTSA designs where the biomechanical relationship between MGLS and deltoid/rotator cuff tension differs.
Original Abstract
BACKGROUND
The purpose of this investigation was to evaluate the impact of scapular neck length (SNL) on outcomes following reverse total shoulder arthroplasty (rTSA) using a lateralized 135° implant (Univers Revers; Arthrex Inc.; Naples, FL). Our hypothesis was that increased postoperative SNL would be associated with improved range of motion (ROM) following rTSA.
METHODS
A multicenter retrospective study was performed on a prospectively collected database. Inclusion criteria were patients undergoing primary rTSA with minimum 2-year follow-up. Preoperative radiographs were analyzed for SNL and glenoid height. Postoperative radiographs were analyzed for scapular notching, inferior glenosphere overhang, effective SNL defined as the distance from medial glenosphere to lateral column of scapula (MGLS), lateralization shoulder angle, and distalization angle. Patient reported outcomes, ROM, and strength at 2 years postoperatively were correlated with outcomes controlling for demographic variables. MGLS was stratified by 0-5 mm, 5-10 mm, and >10 mm for analysis.
RESULTS
A total of 485 patients met inclusion criteria for this investigation. Preoperative SNL was negatively associated with external rotational strength at 2 years postoperatively (P = .039), but was not found to influence patient reported outcomes, ROM, or the incidence of scapular notching (P > .05). Increased postoperative MGLS was positively associated with active internal rotation to the highest spinal level (P = .024) and belly press strength (P < .001). Improved abduction strength was observed with MGLS >10 mm (P = .011) and improved belly press strength was observed with a postoperative MGLS of >5 mm (P < .001). Internal rotation was higher in the >10 mm group compared to the 0-5 mm (L3 vs. L4; P < .001). External rotation at 90° was higher in the >10 mm compared to the 5-10 mm group (73° vs. 57°; P = .013).
CONCLUSION
Increased effective postoperative SNL, or MGLS, is positively associated with rotational ROM and shoulder strength and following rTSA with the Arthrex Univers Revers. Postoperative MGLS of >10 mm is associated with increased Constant strength and belly press strength compared to an MGLS of 0 to 5 mm. The differences in external rotation at 90° in the >10 mm group compared to the 5-10 mm group and for the internal rotation in the 10 mm group compared to the 0-5 mm group met criteria for a substantial clinical benefit.