Functional and ROM outcomes after reverse shoulder arthroplasty. A systematic review comparing anterosuperior and deltopectoral surgical approaches.
Description
Reverse shoulder arthroplasty (RSA), initially developed for cuff-deficient shoulders, has become a widely used treatment with expanding indications including irreparable cuff tears, osteoarthritis, proximal humeral fractures, and cuff tear arthropathy. The two most common approaches are the deltopectoral (DP) and anterosuperior (AS), which differ in technical considerations and associated risks. Although surgical and radiographic outcomes have been well documented, functional and range of motion (ROM) outcomes are less frequently reported despite their direct relevance to patient recovery.
This systematic review compared functional and ROM outcomes following RSA using the DP versus AS approaches. A PubMed search identified 55 eligible studies, with 9 meeting inclusion criteria (Written in English, Level I–III evidence, comparison of DP and AS, and reporting at least one functional outcome: Constant Score [CS], ASES, or ROM measures such as active anterior elevation [AAE], external rotation [ER], or internal rotation [IR]).
Our review found that the DP approach was associated with higher postoperative CS and AAE, with CS gains exceeding the minimal clinically important difference (MCID). The AS approach was linked to greater postoperative ER, though improvements often reflected higher baseline ER. A forest plot meta-analysis supported these trends: DP favored for CS and AAE, AS for ER, with no significant difference in CS overall. However, heterogeneity limited collective interpretation. Radiographic findings such as superior glenoid tilt and scapular notching were more frequent with AS, though their clinical significance remains unclear.
In conclusion, both DP and AS surgical approaches provided comparable outcomes, when evaluating CS, AAE, and ER. Further studies need o be performed to better understand the benefits and consequences of each surgical approach in respect to post-operative function and ROM.
Citation Information
Lu, Angel and Vardaxis, Vassilios, "Functional and ROM outcomes after reverse shoulder arthroplasty. A systematic review comparing anterosuperior and deltopectoral surgical approaches." (2026). Office of Research DMU Research Symposium. 30.
https://digitalcommons.dmu.edu/researchsymposium/2025rs/2025abstracts/30
Functional and ROM outcomes after reverse shoulder arthroplasty. A systematic review comparing anterosuperior and deltopectoral surgical approaches.
Reverse shoulder arthroplasty (RSA), initially developed for cuff-deficient shoulders, has become a widely used treatment with expanding indications including irreparable cuff tears, osteoarthritis, proximal humeral fractures, and cuff tear arthropathy. The two most common approaches are the deltopectoral (DP) and anterosuperior (AS), which differ in technical considerations and associated risks. Although surgical and radiographic outcomes have been well documented, functional and range of motion (ROM) outcomes are less frequently reported despite their direct relevance to patient recovery.
This systematic review compared functional and ROM outcomes following RSA using the DP versus AS approaches. A PubMed search identified 55 eligible studies, with 9 meeting inclusion criteria (Written in English, Level I–III evidence, comparison of DP and AS, and reporting at least one functional outcome: Constant Score [CS], ASES, or ROM measures such as active anterior elevation [AAE], external rotation [ER], or internal rotation [IR]).
Our review found that the DP approach was associated with higher postoperative CS and AAE, with CS gains exceeding the minimal clinically important difference (MCID). The AS approach was linked to greater postoperative ER, though improvements often reflected higher baseline ER. A forest plot meta-analysis supported these trends: DP favored for CS and AAE, AS for ER, with no significant difference in CS overall. However, heterogeneity limited collective interpretation. Radiographic findings such as superior glenoid tilt and scapular notching were more frequent with AS, though their clinical significance remains unclear.
In conclusion, both DP and AS surgical approaches provided comparable outcomes, when evaluating CS, AAE, and ER. Further studies need o be performed to better understand the benefits and consequences of each surgical approach in respect to post-operative function and ROM.
