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Updated: Aug 5, 2026
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Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Superior Internal Rotation after Anatomic vs. Reverse Shoulder Arthroplasty Performed with Lesser Tuberosity
Brendan Y Shi1, Miguel Fiandeiro1, James R Satalich1
1Rothman Orthopaedic Institute, 33 S. 9th Street, 12th floor, Suite 1220, Philadelphia, Pennsylvania 19107.
Journal of Shoulder and Elbow Surgery
|July 31, 2026
Summary
Anatomic total shoulder arthroplasty (aTSA) with standardized lesser tuberosity osteotomy (LTO) shows superior internal rotation compared to reverse total shoulder arthroplasty (rTSA). This suggests aTSA
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Musculoskeletal research
Background:
- Anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are used for glenohumeral osteoarthritis.
- Observed differences in outcomes may be due to subscapularis management (lesser tuberosity osteotomy - LTO) rather than implant design.
- Standardizing LTO management is crucial for comparing aTSA and rTSA outcomes.
Purpose of the Study:
- To compare outcomes between aTSA and rTSA in patients with cuff-intact osteoarthritis when subscapularis management is standardized using LTO.
- To determine if functional differences are intrinsic to implant design or related to surgical technique.
- To evaluate the impact of LTO healing on shoulder range of motion and patient-reported outcomes.
Main Methods:
- Retrospective review of primary aTSA or rTSA cases with LTO (2019-2023).
- Inclusion criteria: glenohumeral arthritis, intact rotator cuff, minimum two-year follow-up.
- Comparison of demographics, range of motion (ROM), and patient-reported outcomes (SANE, ASES, ASPDS, VAS); assessment of LTO healing and glenoid morphology.
Main Results:
- 160 LTO-aTSA and 46 LTO-rTSA patients were analyzed at a mean follow-up of 3.9 years.
- LTO healing occurred in 95% of patients with no significant difference between groups.
- aTSA patients demonstrated superior final ROM, greater improvements in internal and external rotation, and higher SANE and ASES scores.
- Multivariable analysis indicated aTSA was associated with increased odds of internal rotation improvement (OR 4.0, p=0.005).
Conclusions:
- When subscapularis management is standardized with LTO, aTSA provides superior internal rotation compared to rTSA.
- These findings suggest that the range of motion advantages of aTSA are intrinsic to its biomechanics.
- aTSA remains a valuable option for cuff-intact glenohumeral osteoarthritis.