Subscapularis-Sparing Rotator Interval Approach for Anatomic Total Shoulder Arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Musculoskeletal Research

Background:

• Traditional anatomic total shoulder arthroplasty (TSA) necessitates subscapularis tendon release and repair, which can lead to significant complications.
• Subscapularis dysfunction post-TSA, including tears, is prevalent, impacting patient function, stability, and pain.
• Current postoperative protocols to protect the subscapularis repair may result in stiffness and reduced patient satisfaction.

Purpose of the Study:

• To describe and evaluate a novel subscapularis-sparing approach for anatomic TSA.
• To address and overcome technical challenges associated with traditional TSA, including humeral neck osteotomy visualization and component sizing.
• To potentially mitigate subscapularis-related complications and improve functional outcomes after shoulder arthroplasty.

Main Methods:

• A subscapularis-sparing surgical technique for anatomic TSA is detailed, involving a 7 to 10-cm anterosuperior incision.
• Key steps include splitting the deltoid raphe, biceps tenodesis, and creating a "trapdoor" flap of interval tissue without subscapularis release.
• Standard glenoid preparation and component insertion, followed by humeral head osteotomy and component implantation, are performed using trial components for accurate sizing.

Main Results:

• The described technique allows for direct visualization and accurate execution of the humeral neck cut.
• It facilitates adequate resection of humeral osteophytes and precise humeral head sizing.
• The "trapdoor" flap is securely repaired, and the deltoid is reattached, completing the arthroplasty.

Conclusions:

• The subscapularis-sparing TSA technique offers a viable alternative to traditional methods, potentially reducing subscapularis-related morbidity.
• This approach addresses specific technical difficulties, aiming for improved accuracy in component placement and sizing.
• Further clinical studies are warranted to validate the long-term efficacy and patient-reported outcomes of this subscapularis-sparing method.