Influence of musculotendinous stabilizers on the shoulder stability before and after implantation of a reverse shoulder prosthesis. An integrated in silico and in vitro study, considering passive and active musculature.

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The implantation of a reverse shoulder joint prosthesis (ISP has been established as an effective surgical method for improving active shoulder joint mobility and pain reduction in patients with cuff tear arthropathy. However, due to the deficient muscular stabilizers in a substantial proportion of patients, the procedure leads to a postoperative luxation of the prosthesis. Influencing factors wich lead to an instability of the shoulder or an inadequate range of motion after implantation of an ISP, may be the orientation of the prosthetic components as well as the underlying pathology of the patient, a chronic rotator cuff. The key problem of the reverse shoulder arthroplasty treatment in patients with a residual rotator cuff is the lack of information regarding the damage pattern dependant risk of instability after the treatment. Although the surgical care of patients with an ISP provides good results, there is still a lack of information regarding the optimal soft tissue management for the treatment of a patient with a deficient rotator cuff in order to achieve maximum stability and range of motion. Therefore, the two main objectives of this research project are ,1. to investigate the role of the soft tissue tension and in particular the effect of individual musculotendinous stabilizers on the stability of the shoulder before and after implantation of a reverse shoulder joint prosthesis.2. to determine the optimum soft-tissue management, depending on the patient's individual pattern of damage of the musculotendinous stabilizers in order to achieve optimum stability of the joint and a maximum range of motion for a prosthetic restoration.