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.

反式肩关节假体（ISP）的植入已被确立为改善肩袖撕裂关节病患者主动肩关节活动度和减轻疼痛的有效手术方法。然而，由于大部分患者的肌肉稳定剂不足，该手术导致假体术后脱位。导致肩关节不稳定或植入ISP后活动度不足的影响因素可能是假体组件的方向以及患者的潜在病理学，慢性肩袖。反向肩关节成形术治疗肩袖残留患者的关键问题是缺乏关于损伤模式相关的治疗后不稳定风险的信息。虽然ISP患者的手术治疗效果良好，但仍缺乏关于肩袖缺陷患者治疗的最佳软组织管理的信息，以实现最大的稳定性和活动范围。 因此，本研究课题的两个主要目标是：1.研究软组织张力的作用，特别是在反向肩关节假体植入前后，单个肌腱稳定器对肩关节稳定性的影响.根据患者的肌腱稳定器损伤的个体模式确定最佳软组织管理，以实现关节的最佳稳定性和假体修复的最大活动范围。

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.