Clinical and radiological outcomes following complete release of the long head of triceps in reverse shoulder arthroplasty

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Abstract
Background: Complete long head of the triceps release (LHTR) during reverse shoulder arthroplasty (RSA) aims to eliminate inferior impingement and ensures tether-free range of motion (ROM). However, it remains infrequently performed due to concerns such as triceps strength deficits and instability. This study aimed to present the clinical and radiological outcomes following RSA with LHTR, focusing on the impact on triceps strength. Methods: This was a retrospective review of patients who underwent primary RSA with LHTR. The primary outcome was 2-year triceps strength compared with the preoperative strength. Secondary outcomes were the improvement of shoulder ROM, Constant Score, American Shoulder and Elbow (ASES) Score, and Visual Analog Score (VAS) at 2-year postoperative time point, and radiological outcomes including notching and heterotopic ossification (HO). Results: Eighty patients were included with mean age of 71.1 years. Two-year triceps strength was comparable to the preoperative strength (6.3 kg vs. 6.2 kg, p = .703). Active ROM, VAS, ASES, and Constant scores significantly improved at 2 years postoperatively (p < .001). Notching was present in 15% of patients while HO was present in 18.75%. There were no dislocations or neurovascular injuries. Discussion: Complete LHTR during RSA appears safe with no adverse effect on triceps strength, patient-reported outcomes, or stability.

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