Background: The ideal method for management of the subscapularis tendon during anatomic total shoulder arthroplasty (TSA) remains controversial.
Methods: In a retrospective cohort study, primary anatomic TSA procedures performed with either a subscapularis peel or a lesser tuberosity osteotomy from 2002 to 2010 were reviewed at a minimum 1-year follow-up. The primary outcome measure was the performance of a normal lift-off test postoperatively. Multivariate logistic regression analysis was performed to determine if other covariates besides surgical technique correlated with an abnormal lift-off test result.
Results: Ninety TSA procedures were evaluated. Forty-six procedures were performed with subscapularis peel, and 44 were performed with lesser tuberosity osteotomy. Mean follow-up was 4 years. In the subscapularis peel group, 32 of 46 shoulders (69.6%) had a normal lift-off test, compared with 40 of 44 shoulders (90.9%) in the lesser tuberosity osteotomy group (P = 0.01). The results of multivariate logistic regression suggested that lesser tuberosity osteotomy was associated with a normal postoperative lift-off test 4.5 times more often than was subscapularis peel.
Conclusions: Our study suggests that the use of lesser tuberosity osteotomy as the surgical approach for anatomic TSA is a reliable option that provides the patient with a better chance of maintaining subscapularis function postoperatively than the subscapularis peel does.
Level of Evidence: Level III retrospective cohort study
From the Department of Orthopaedics and Rehabilitation, University of Vermont Larner College of Medicine, Burlington, VT.
Correspondence to Dr. Shafritz: adam.shafritz@med.uvm.edu
None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Shafritz, Dr. Fitzgerald, Dr. Beynnon, and Mr. DeSarno.
Received February 17, 2016
Accepted November 16, 2016
