Deltopectoral approach for shoulder arthroplasty: anatomic basis

Area of Science:

• Orthopedic Surgery
• Shoulder Arthroplasty
• Surgical Techniques

Background:

• The deltopectoral approach is a standard surgical method for shoulder arthroplasty.
• Controversies exist regarding specific steps, particularly subscapularis management (tenotomy vs. lesser tuberosity osteotomy).

Purpose of the Study:

• To provide a toolkit for inexperienced surgeons on the deltopectoral approach.
• To analyze challenging aspects of the deltopectoral approach for experienced surgeons.
• To present an original technique for subscapularis reattachment.

Main Methods:

• Detailed description of tips and tricks for glenoid exposure.
• Comparative analysis of challenging deltopectoral approach steps against literature.
• Description of a novel technique for subscapularis reattachment using a "corner buttress".

Main Results:

• An original technique for subscapularis reattachment after lesser tuberosity osteotomy is described.
• The technique involves sculpting the osteotomy fragment for enhanced stability against the prosthetic cup.
• The method aims to improve the stability of the subscapularis.

Conclusions:

• There is no single preferred deltopectoral approach; multiple options exist.
• Respecting anatomic planes is crucial for atraumatic dissection.
• Key points include using the subacromial deltoid bursa plane, staying close to bone during capsule release, and avoiding medial dissection near the conjoint tendon.