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Subscapularis Function After Total Shoulder Arthroplasty Using Lesser Tuberosity Osteotomy or Tenotomy.

Patrick M OʼBrien1, Jack E Kazanjian, James D Kelly

  • 1From Avera Medical Group Orthopedics and Sports Medicine, Sioux Falls, SD (Dr. O'Brien); Llanerch Orthopaedics, Havertown, PA (Dr. Kazanjian); San Francisco Shoulder Elbow and Hand Clinic, San Francisco, CA (Dr. Kell); and Mississippi Sports Medicine and Orthopaedic Center, Jackson, MS (Dr. Hobgood).

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Summary

Lesser tuberosity osteotomy (LTO) and subscapularis tenotomy (ST) during total shoulder arthroplasty (TSA) yield similar clinical outcomes. Subscapularis management choice did not impact strength or overall shoulder function in this study.

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Area of Science:

  • Orthopedic Surgery
  • Shoulder Arthroplasty
  • Musculoskeletal Biomechanics

Background:

  • Subscapularis dysfunction is a known complication following total shoulder arthroplasty (TSA).
  • Optimal surgical management of the subscapularis tendon during TSA remains a topic of debate.
  • Lesser tuberosity osteotomy (LTO) is increasingly favored over subscapularis tenotomy (ST).

Purpose of the Study:

  • To compare the clinical outcomes of TSA using either LTO or ST.
  • To evaluate the impact of subscapularis management on subscapularis strength and overall shoulder function.

Main Methods:

  • Retrospective review of TSA cases (2010-2016) managed with LTO or ST.
  • Assessment of patient demographics, radiographic union, range of motion, and American Shoulder and Elbow Surgeons (ASES) scores.
  • Objective measurement of subscapularis strength via resisted belly-press test.

Main Results:

  • No significant differences in patient demographics or follow-up duration between LTO and ST groups.
  • Equivalent range of motion and ASES scores were observed in both groups.
  • Subscapularis strength and overall function showed no statistically significant differences between LTO and ST management.

Conclusions:

  • Both LTO and ST are viable techniques for subscapularis management during TSA.
  • The choice between LTO and ST does not appear to influence subscapularis strength or functional outcomes post-TSA.