Biomechanical comparison of subscapularis peel and lesser tuberosity osteotomy for double-row subscapularis repair technique in a cadaveric arthroplasty model

Virk, Mandeep S.; Aiyash, Saleh; Frank, Rachel M.; Mellano, Christopher S.; Shewman, Elizabeth; Wang, Vincent; Romeo, Anthony A.

doi:10.1186/s13018-019-1372-x

Cited by 11 publications

(9 citation statements)

References 24 publications

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“…Effective subscapularis repair 71 during surgery is therefore mandatory; a review of biomechanical cadaveric studies suggests superior load to failure for the osteotomy at time zero but no difference at cyclic loading. 72 , 73 While de Wilde suggested that a C-block lesser tuberosity osteotomy might prevent postoperative subscapularis fatty infiltration, a recent systematic review reported no statistical difference in clinical and radiological outcomes between tenotomy, peel and osteotomy. 74 – 76 In case of postoperative rupture, a prompt secondary repair can be considered to prevent instability but has been associated with variable results.…”

Section: Anatomic Total Shoulder Arthroplasty (Atsa)mentioning

confidence: 99%

Biomechanics of anatomic and reverse shoulder arthroplasty

et al. 2021

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The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics. With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening. The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis. The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont’s reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm. More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014

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Section: Anatomic Total Shoulder Arthroplasty (Atsa)mentioning

confidence: 99%

Biomechanics of anatomic and reverse shoulder arthroplasty

et al. 2021

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“…While the limitations of ST have caused a shift toward LTO and SP for subscapularis management, many studies have reported no difference between LTO and SP repairs. 5,7,10 In a biomechanical study comparing LTO and SP, Buraimoh et al found no differences in repair gapping, fatigue failure, or load to fatigue. 13 In their randomized controlled trial evaluating a cohort of 43 patients with LTO or SP, Lapner et al found no differences between the two techniques with regard to postoperative strength or patient-reported outcome scores.…”

Section: Discussionmentioning

confidence: 99%

“…Subscapularis management remains an area of active debate with several different techniques currently employed, including a subscapularis tenotomy (ST), subscapularis peel (SP), or a lesser tuberosity osteotomy (LTO). [4][5][6][7] ST has been the traditional approach to the TSA, as it provides easy access to the glenohumeral joint while leaving a tendon stump for direct tendon to tendon repair. However, many complications have been reported regarding the lack of subscapularis function after TSA, and in some cases, it is difficult to complete an adequate repair.…”

Section: Introductionmentioning

confidence: 99%

Fig 1 (A) Anteroposterior radiograph of a left shoulder demonstrating glenohumeral arthritis with three prior anterior glenoid metal anchors and joint space obliteration, indicating the need for TSA. (B) Axillary radiograph of a left shoulder demonstrating glenohumeral arthritis with three prior anterior glenoid metal anchors and joint space obliteration, indicating the need for TSA.…”

Section: Introductionmentioning

confidence: 99%

“… 8 , 9 Although some studies have shown improved functional outcomes with an LTO, many others have noted equivalence between LTO and SP. 5 , 7 , 10 An improved methodology for completing the repair of the SP or ST (this technique can be used for both), which yields successful patient outcomes when performed correctly, 11 is the subject of this technique article. The purpose of this Technical Note is to describe in detail a technique for fixation of SP or ST with the goal of improving outcomes after total shoulder arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

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Subscapularis Repair Prior to Subscapularis Takedown in Anatomic Shoulder Arthroplasty: Improving Anatomic Restoration and Mechanics of the Subscapularis

Lilley¹,

Ruzbarsky

Eble

et al. 2022

Arthroscopy Techniques

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Traditionally, total shoulder arthroplasty is performed using a deltopectoral approach through which the glenohumeral joint is accessed by mobilization of the subscapularis. Despite several variations on the subscapularis management techniques, postoperative complications, including subscapularis deficiency and lower functional outcomes, remain an area for improvement. The purpose of this Technical Note is to describe in detail our technique for management of the subscapularis in the setting of a stemless humeral implant through which the repair is planned and almost entirely performed at the beginning of the case, prior to the subscapularis peel. This technique aims to improve outcomes after total shoulder arthroplasty by 1) avoiding the anatomic implant with anchor drilling, 2) improving procedure efficiency, and 3) anatomically "repairing" the subscapularis prior to takedown by placing anchors exactly at the repair-tension site.

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