As such, the deltoid requires special attention during reconstruction of the scapular girdle [2, 6–9, 14]. Wittig et al. [10] also demonstrated the importance of covering the scapula prostheses with a vascularized and functional deltoid. Reconstruction of the residual or uninvolved deltoid also allows for myodesis with the functional trapezius and acts as a potential abductor mechanism. Therefore, the articular capsule, together with the deltoid, Ku-0059436 research buy provides a dynamic stabilizer

for the glenohumeral joint and both structures should be reconstructed whenever possible. Preservation of both the rotator cuff and deltoid significantly influenced the eventual shoulder abduction see more capacity in the series of patients described herein. Yasojima et al. [20] demonstrated significant electromyogram activity of the supraspinatus and the middle deltoid during scapular plane abduction. The rotator cuff provides a medially and inferiorly directed force vector on the humeral head, which stabilizes the humeral head against the glenoid [21]. In this study, four patients with adequate rotator cuff reconstruction had significantly better shoulder function compared with the three patients whose rotator cuffs were resected.

Thus, it is recommended to preserve the rotator cuffs when possible, as previously suggested [2–4]. Unfortunately, the rotator cuffs, especially the posterosuperior ones, often require resection (as illustrated by the patients included in this case series) making it difficult to preserve the affected rotator cuff while achieving a safe surgical margin. Thus,

we 6-phosphogluconolactonase suggest that the remaining external rotator can be reattached when the posterosuperior rotator cuff is resected. In patients with a deficient rotator cuff, however, movement of the deltoid should be able to assist in achieving acceptable shoulder function [5]. Therefore, preservation of the deltoid muscle length, when possible, will help increase deltoid moment [22] and maintain shoulder abduction capacity. Additionally, the affected muscle(s) around the thoracoscapular joint is known to be less correlated with stability and function of the glenohumeral joint and does not need to be reattached to obtain thoracoscapular rhythm. Use of a scapular allograft with satisfactory shoulder function has previously been demonstrated [3, 4, 12]. The mean ISOLS score reported in this case series was 80% but only 78.5% and 74% in the studies reported by Pritsch and Asavamongkolkul, respectively [8, 6]. The glenoid-saved reconstruction technique may better ensure the position and direction of the glenoid and better contribute to the stability of the glenohumoral joint due to the preserved articular capsule. In turn, this is likely a key factor in preventing anteroposterior shoulder dislocation.