Subscapularis tenotomy versus lesser tuberosity osteotomy during total shoulder replacement: a comparison of patient outcomes. JSES

The October JSES published Subscapularis tenotomy versus lesser tuberosity osteotomy during total shoulder replacement: a comparison of patient outcomes. The authors retrospectively reviewed shoulders having total shoulder replacement, 10 with subscapularis tenotomy and 26 with lesser tuberosity osteotomy.  While patients having osteotomy tended to have better 'belly-press' scores, the clinical results were not significantly better for this group. The patients were not randomized and the tenotomy cases were apparently done earlier in the surgeon's experience than the osteotomy cases, so the two groups cannot be directly compared. The most important finding in this study was that patients with a functionally intact subscapularis (by the belly-press test), whether having tenotomy or osteotomy, had better clinical outcomes. The authors performed routine biceps tenotomy and recommend avoiding external rotation beyond neutral for the first six weeks to protect the repair.

A recent cadaveric study did not find differences in strength of repair.

We continue to use subscapularis tenotomy with secure transosseous repair for all our shoulder arthroplasties, preserving the long head of the biceps when it is healthy. As the authors of the recent paper point out, it is important to protect all subscapularis repairs during the period of healing.

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