Sunday, October 13, 2013

Cadaver study of lesser tuberosity osteotomy - small vs. large vs. none

Biomechanical testing of small versus large lesser tuberosity osteotomies: effect on gap formation and ultimate failure load

These authors compared the strength of different repair techniques using 20 fresh frozen cadaveric shoulders. The repair methods included traditional subscapularis tenotomy, dual-row fleck lesser tuberosity osteotomy compared with techniques of single-cable and 2-suture large lesser tuberosity repairs.

They found no significant difference in ultimate failure load among the repair techniques. But they suggest that the advantages of a 2-suture large osteotomy technique include the minimum amount of suture, avoidance of metallic hardware, and greater access to the glenoid.

We avoid lesser tuberosity osteotomy in performing shoulder arthroplasty because (1) we want to preserve the stabilizing effect of the biceps tendon in the majority of cases (when it is not frayed or unstable), (2) we do not want to compromise the integrity of the humerus with an unnecessary osteotomy, (3) we have not had problems with subscapularis failure when it is incised from the lesser tuberosity and repaired back to bone using six #2 non-absorbable sutures, and (4) the clinical evidence of the advantages of an osteotomy is at this point not convincing.

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