Subscapularis Takedown and Repair with Shoulder Arthroplasty

Non-healing or rupture of the subscapularis tendon repair following total shoulder arthroplasty is a recognized complication of the transtendinous approach.  Deficiency of the subscapularis tendon can lead to poor results after total shoulder arthroplasty.  Patients may complain of pain and difficulty with simple tasks like reaching the contralateral axilla or getting the arm behind the back to tuck in a shirt or reach into a back pocket.  In addition, instability of the prosthesis, ranging from subluxations to overt dislocation, may occur.  This has prompted some investigators to study osteotomy of the lesser tuberosity during surgical approach in shoulder arthroplasty.  Lesser tuberosity osteotomy repair results in bone-to-bone healing, which may be more reliable than tendon-to-tendon or tendon-to-bone healing.  While several studies have been published examining results of lesser tuberosity osteotomy following total shoulder arthroplasty in patients with glenohumeral osteoarthritis, they did not meet our inclusion criteria.  Thus, the current available literature is insufficient to recommend for or against a lesser tuberosity osteotomy over a trans tendonous approach.