TOTAL SHOULDER ARTHROPLASTY – SUBSCAPULARIS PEEL, LESSER TUBEROSITY OSTEOTOMY, TENOTOMY
Moderate quality evidence supports that surgeons can utilize subscapularis peel, lesser tuberosity osteotomy, or tenotomy when performing shoulder arthroplasty

Rationale

The subscapularis tendon must be mobilized to gain exposure to the glenohumeral joint.  Several studies have described subscapularis dysfunction following repair of a subscapularis tenotomy just medial to the lesser tuberosity or a detachment of the subscapularis from the lesser tuberosity (subscapularis peel).  Deficiency of the subscapularis can lead to poor results after shoulder arthroplasty.  Patients may complain of pain and difficulty with functional tasks such as tucking in a shirt or reaching the back pocket.  This has prompted 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.  Two high quality studies (Lapner, et al. 2012, 2013), analyzing the same cohort and 2 lower quality studies resulted in no clinically significant differences among the three surgical techniques.

 

Strength of Evidence (quality of evidence): Moderate

 

Future Research:  Current studies report follow up at 12- and 24-months post-op.  Future studies should investigate longer term comparison of the three surgical techniques.


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