Lesser tuberosity osteotomy - a cadaver study

EFFECT OF LESSER TUBEROSITY OSTEOTOMY SIZE AND REPAIR CONSTRUCT DURING TOTAL SHOULDER ARTHROPLASTY

This is a master's thesis from Pittsburg. While we do not use lesser tuberosity in our arthroplasty practice, this is a nice study and deserves review for those interested in this method.

The author studied two types of osteotomy, a thick osteotomy (100% lesser tuberosity height) or a thin (50% height) osteotomy.  The author also studied two types of repair,  either compression-sutures alone or  compression sutures plus one tension suture.  CT scans were used to measure tuberosity dimensions pre- and post-osteotomy. The repairs were loaded cyclically and then loaded to failure. A video system measured fragment displacement. Percent area of osteotomy contact was calculated from the CT and displacement data.
 

The average initial displacement was less in the thin osteotomy groups. Adding a tension-suture negated this difference. A significantly greater number of thin compared to thick repair sites remained intact during load to failure.  Construct stiffness was greater when a tension-suture was used.

The author concluded the ideal repair was a thin wafer with both tension and compression sutures. This construct had smaller total displacement, a reasonable osteotomy percent contact area, and acceptable maximum load.

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