The Impact of Lesser Tuberosity Osteotomy Repair After Reverse Total Shoulder Arthroplasty: A Randomized Controlled...

Area of Science:

• Orthopedic Surgery
• Shoulder Reconstruction
• Biomechanical Research

Background:

• Reverse total shoulder arthroplasty (rTSA) is a common procedure for complex shoulder conditions.
• Management of the subscapularis tendon during rTSA is a subject of ongoing debate.
• Subscapularis integrity is crucial for shoulder function, particularly internal rotation.

Purpose of the Study:

• To prospectively compare functional outcomes of rTSA with and without subscapularis tendon repair.
• To evaluate the impact of lesser tuberosity osteotomy (LTO) repair on shoulder function after rTSA.
• To determine if subscapularis reattachment influences internal rotation and overall shoulder scores.

Main Methods:

• A patient-blinded randomized controlled trial was conducted.
• Patients with intact subscapularis tendons suitable for reattachment were enrolled.
• Participants were randomized to either LTO repair or no repair, with outcomes assessed using ASES scores and functional tests.

Main Results:

• The LTO repair group showed significantly better American Shoulder and Elbow Surgeons (ASES) scores at 2-year follow-up (90.4 vs. 82.3, p=0.01).
• Subscapularis repair resulted in seven times higher odds of improved internal rotation range of motion.
• No significant differences were observed in other active shoulder motions or general outcome scores between the groups.

Conclusions:

• Subscapularis reattachment via LTO repair in primary rTSA leads to superior functional outcomes and internal rotation.
• The benefits of subscapularis repair were achieved without negatively impacting other shoulder movements.
• LTO repair is a recommended surgical consideration for subscapularis management in rTSA.