[Surgical approach to the shoulder. Lesser tuberosity osteotomy]

Osteotomy of the lesser tuberosity for the surgical delto-pectoral approach to the glenohumeral joint results in good visualization and overview and sufficient anatomical refixation of the insertion of the subscapularis muscle. However, clinical and biomechanical studies have not shown clearly significantly better results for osteotomy concerning ultimate load to failure, displacement after cyclic loading and outcome in patients compared with tenotomy and tenodesis of the subscapularis tendon. One advantage of osteotomy, however, is the potential radiological evaluation of the refixation with healing of the bony fragment. In the context of refixation, securing of the sutures behind the stem during implantation can be beneficial because it prevents sutures cutting through the bone. This benefit is increased in cemented stems by means of better suture fixation. With respect to the choice of osteotomy or tenotomy, the bony substance and tendon quality of the insertion of the subscapularis muscle should be evaluated.