The subscapularis-sparing approach in humeral head replacement

Area of Science:

• Orthopedic Surgery
• Shoulder Reconstruction
• Musculoskeletal Imaging

Background:

• Evaluating an open deltopectoral approach for humeral head replacement without complete subscapularis tendon takedown.
• Hypothesizing that preserving the superior subscapularis tendon border decreases repair failures and fatty infiltration.
• Aiming to enable accelerated rehabilitation protocols post-surgery.

Purpose of the Study:

• To assess the radiological and clinical outcomes of a subscapularis-sparing approach in humeral head replacement.
• To evaluate the integrity and function of the subscapularis tendon after this novel surgical technique.
• To determine if this approach leads to improved patient-reported outcomes and reduced complications.

Main Methods:

• Prospective case series of 50 patients undergoing humeral head replacement with a subscapularis-sparing approach.
• Incomplete subscapularis tendon takedown, preserving the superior aspect.
• Postoperative assessment included imaging (MRI/ultrasound) and clinical evaluations (strength tests, functional scores).

Main Results:

• All patients demonstrated intact subscapularis tendon attachment post-surgery, confirmed by imaging.
• Subscapularis strength was equal to the contralateral side, assessed by multiple clinical tests.
• Significant improvements in patient-reported outcome scores were observed, excluding general health.

Conclusions:

• A subscapularis-sparing approach provides sufficient exposure for humeral head replacement.
• Maintaining the superior subscapularis insertion intact reduces the risk of postoperative tendon failure.
• This technique facilitates a safe and effective shoulder replacement with favorable tendon integrity.