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Lesser Tuberosity Osteotomy With Cerclage Wire Repair for Total Shoulder Arthroplasty: Surgical Technique

Byram, Ian R. MD; Shillingford, Jamal N. BS; Fink, Leslie A. MD; Ramirez, Jose M. MA; Ahmad, Christopher S. MD

Techniques in Shoulder & Elbow Surgery: December 2012 - Volume 13 - Issue 4 - p 151–156
doi: 10.1097/BTE.0b013e31825aadb8

Total shoulder arthroplasty has been widely accepted as an effective treatment for patients suffering from primary glenohumeral osteoarthritis. The traditional deltopectoral approach involves mobilization of the subscapularis tendon by tenotomy, followed by a soft-tissue repair of the tendon. The high prevalence of subscapularis dysfunction after total shoulder arthroplasty has stimulated much interest in alternative techniques for mobilizing the subscapularis tendon. There has been a recent shift toward using a lesser tuberosity osteotomy (LTO) during the deltopectoral approach to the glenohumeral joint. Reports indicate that this method enhances glenoid exposure, provides a stronger repair with desirable bone-to-bone healing, can be easily monitored radiographically, and results in lower rates of subscapularis dysfunction postoperatively. Previously described LTO techniques primarily involve suture repair in parallel rows of bone tunnels drilled along the medial and lateral borders of the osteotomy site. The current study describes a modified technique and early results for LTO repair, minimizing the number of drill holes by the use of cerclage wire fixation.

Department of Orthopaedic Surgery, Centers for Orthopaedic Research and Shoulder, Elbow and Sports Medicine, New York-Presbyterian Medical Center, Columbia University, New York, NY

The authors declare no conflict of interest.

Reprints: Christopher S. Ahmad, MD, Department of Orthopaedic Surgery, 622 W 168th Street, New York, NY 10032 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.