Biomechanical comparison of lesser tuberosity osteotomy versus subscapularis tenotomy in total shoulder arthroplasty

Giuseffi, Steven A.; Wongtriratanachai, Prasit; Omae, Hiromichi; Çil, Akın; Zobitz, Mark E.; An, Kai Nan; Sperling, John W.; Steinmann, Scott P.

doi:10.1016/j.jse.2011.07.008

Cited by 65 publications

(58 citation statements)

References 17 publications

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“…These techniques have included lesser tuberosity osteotomy, varying suture patterns, and soft tissue reinforcement techniques. 1,5,6,11,13,15,23,30 Surgeons have recently been trying to address this problem by avoiding takedown of the subscapularis. Lafosse et al described total shoulder arthroplasty through the rotator interval without detachment of any of the subscapularis, 14 but it was limited by an inability to remove inferior humeral spurs by this approach.…”

Section: Discussionmentioning

confidence: 99%

The subscapularis-sparing approach in humeral head replacement

Savoie

Charles

Casselton

et al. 2015

Journal of Shoulder and Elbow Surgery

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Section: Discussionmentioning

confidence: 99%

The subscapularis-sparing approach in humeral head replacement

Savoie

Charles

Casselton

et al. 2015

Journal of Shoulder and Elbow Surgery

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“…A biomechanical comparison of 20 paired shoulders comparing LTO fixation to tenotomy fixation demonstrated no significant difference in load to failure. 20 The tenotomy group demonstrated significantly less displacement during cyclic testing.…”

Section: Biomechanicsmentioning

confidence: 88%

Surgical Approach and Dealing With the Subscapularis in Primary Shoulder Arthroplasty

Rollins¹,

Lapner²

2016

Techniques in Shoulder &Amp; Elbow Surgery

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The optimal management of the subscapularis tendon during total shoulder arthroplasty remains controversial. Subscapularis mobilization is required to gain access to the glenohumeral joint during the deltopectoral approach. Failure of the subscapularis to heal, or postoperative rupture, has been associated with poor clinical outcomes. Current evidence supporting subscapularis tenotomy, lesser tuberosity osteotomy, and subscapularis peel are summarized, as surgical techniques. Regardless of technique used, an anatomic and substantial repair with heavy nonabsorbable stitches and plate augmentation is necessary to withstand gentle postoperative rehabilitation. Lack of consensus may be due to difficulty of reliable clinical assessment of subscapularis function after shoulder arthroplasty and lack of agreement between clinical studies comparing techniques.

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“…Many authors have reported good results with subscapularis tenotomy, 20,21 whereas other retrospective studies comparing the 2 techniques have shown that LTO results in a better clinical outcome with a lower rate of subscapularis dysfunction. 9,11,22 One study looking at subscapularis function after tenotomy in TSA found a 50% rupture rate as confirmed by ultrasound, whereas another reported a 66% rate of clinical subscapularis dysfunction at long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Lesser Tuberosity Osteotomy With Cerclage Wire Repair for Total Shoulder Arthroplasty

Byram

Shillingford

Fink

et al. 2012

Techniques in Shoulder &Amp; Elbow Surgery

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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 softtissue 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.Key Words: lesser tuberosity osteotomy, cerclage wire repair, total shoulder arthroplasty (Tech Should Surg 2012;13: 151-156) T otal shoulder arthroplasty (TSA) has proven effectiveness in treating glenohumeral arthritis, providing long-term pain relief and functional improvement. 1 Despite multiple changes and advancements in prosthetic design and materials, the deltopectoral approach remains the standard method of access to the glenohumeral joint. Takedown of the subscapularis insertion, either by tenotomy or lesser tuberosity osteotomy (LTO), is requisite for this approach. Preservation of subscapularis muscle function postoperatively is paramount. 2-6 A high incidence of subscapularis dysfunction after TSA has been reported with traditional techniques, highlighting the importance of new and improved methods of subscapularis repair. 3,7,8 The ideal method of subscapularis mobilization and repair remains widely debated in the literature. 9-13 Healing of the subscapularis tendon after tenotomy can occur through tendon-to-tendon or tendon-to-bone healing depending on technique. 3,7,8,13 When the tendon is released directly from the bone and repaired with transosseous sutures, the result is an altered insertional footprint of the tendon with decreased contact area. A combined tendon-to-bone and tendon-totendon repair may be performed after tenotomy to produce a biomechanically stronger repair than transosseous repair alone. 13 Unique to LTO, however, the subscapularis insertion is restored through bone-to-bone healing and its insertional footprint remains unaltered. Retrospective comparison has shown this method of repair to be more predictable than tendon-to-tendon healing after tenotomy. 9 Healing progress can also be followed on standard radiographs, whereas assessment of tendon-to-tendon healing requires additional imaging such as ultrasound or magneti...

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Biomechanical comparison of lesser tuberosity osteotomy versus subscapularis tenotomy in total shoulder arthroplasty

Cited by 65 publications

References 17 publications

The subscapularis-sparing approach in humeral head replacement

The subscapularis-sparing approach in humeral head replacement

Surgical Approach and Dealing With the Subscapularis in Primary Shoulder Arthroplasty

Lesser Tuberosity Osteotomy With Cerclage Wire Repair for Total Shoulder Arthroplasty

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