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Lift-off Test Results After Lesser Tuberosity Osteotomy Versus Subscapularis Peel in Primary Total Shoulder Arthroplasty

Shafritz, Adam B. MD; Fitzgerald, Michael G. MD; Beynnon, Bruce D. PhD; DeSarno, Michael J. MS

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: April 2017 - Volume 25 - Issue 4 - p 304–313
doi: 10.5435/JAAOS-D-16-00138
Research Article

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:

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

© 2017 by American Academy of Orthopaedic Surgeons
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