In the JournalsPerspective

Subscapularis tenotomy, lesser tuberosity osteotomy had comparable outcomes for TSA

William Levine headshot
William N. Levine

Patients undergoing total shoulder arthroplasty with either subscapularis tenotomy or lesser tuberosity osteotomy had comparable successful subjective and objective clinical outcomes, according to results.

“Over the last decade there was controversy regarding the best approach for shoulder arthroplasty—subscapularis tenotomy vs. lesser tuberosity osteotomy with proponents on both sides of the equation (often done in a retrospective, non-randomized fashion),” William N. Levine, MD, co-author of the study, told Healio.com/Orthopedics. “Therefore, we initiated a prospective, randomized trial to better understand if there was a significant difference for our patients.”

Levine and colleagues randomly assigned 60 shoulders with primary osteoarthritis undergoing total shoulder arthroplasty (TSA) to either the subscapularis tenotomy group (n=30) or the lesser tuberosity osteotomy group (n=30). Researchers collected preoperative and 6-week, 3-month, 6-month and 1-year postoperative data. Operative time, tenotomy or osteotomy repair time and osteotomy thickness were included in the intraoperative data. Ultrasound and radiographs were used in the tenotomy and osteotomy groups, respectively, to evaluate healing at 3 months.

Results showed the two groups had no significant differences in range of motion or clinical outcomes at baseline or 1 year postoperatively. Patients in the subscapularis tenotomy group had a significantly shorter mean total case duration, as well as a significantly shorter repair time vs. the lesser tuberosity osteotomy group, researchers noted. According to results, 93.1% of shoulders in the lesser tuberosity osteotomy group showed bone-to-bone healing on radiographs at final follow-up and 86.7% of shoulders in the subscapularis tenotomy group had no full-thickness tears on ultrasound at 3 months.

“After completing this study, we feel comfortable in concluding that both approaches are acceptable and one is not superior to the other,” Levine said. “Complications can occur with either approach but in general, they both lead to reproducible results in the majority of the patients undergoing shoulder arthroplasty.” – by Casey Tingle

 

Disclosures: The authors report no relevant financial disclosures.

William Levine headshot
William N. Levine

Patients undergoing total shoulder arthroplasty with either subscapularis tenotomy or lesser tuberosity osteotomy had comparable successful subjective and objective clinical outcomes, according to results.

“Over the last decade there was controversy regarding the best approach for shoulder arthroplasty—subscapularis tenotomy vs. lesser tuberosity osteotomy with proponents on both sides of the equation (often done in a retrospective, non-randomized fashion),” William N. Levine, MD, co-author of the study, told Healio.com/Orthopedics. “Therefore, we initiated a prospective, randomized trial to better understand if there was a significant difference for our patients.”

Levine and colleagues randomly assigned 60 shoulders with primary osteoarthritis undergoing total shoulder arthroplasty (TSA) to either the subscapularis tenotomy group (n=30) or the lesser tuberosity osteotomy group (n=30). Researchers collected preoperative and 6-week, 3-month, 6-month and 1-year postoperative data. Operative time, tenotomy or osteotomy repair time and osteotomy thickness were included in the intraoperative data. Ultrasound and radiographs were used in the tenotomy and osteotomy groups, respectively, to evaluate healing at 3 months.

Results showed the two groups had no significant differences in range of motion or clinical outcomes at baseline or 1 year postoperatively. Patients in the subscapularis tenotomy group had a significantly shorter mean total case duration, as well as a significantly shorter repair time vs. the lesser tuberosity osteotomy group, researchers noted. According to results, 93.1% of shoulders in the lesser tuberosity osteotomy group showed bone-to-bone healing on radiographs at final follow-up and 86.7% of shoulders in the subscapularis tenotomy group had no full-thickness tears on ultrasound at 3 months.

“After completing this study, we feel comfortable in concluding that both approaches are acceptable and one is not superior to the other,” Levine said. “Complications can occur with either approach but in general, they both lead to reproducible results in the majority of the patients undergoing shoulder arthroplasty.” – by Casey Tingle

 

Disclosures: The authors report no relevant financial disclosures.

    Perspective

    Levine and colleagues have performed an excellent randomized controlled trial attempting to answer one of the questions that still plagues shoulder arthroplasty surgeons: What is the best subscapularis take-down technique? Their results show no difference in clinical outcomes at 1 year postoperative, with slightly longer operative time in the lesser tuberosity osteotomy group vs. the subscapularis tenotomy group. Additionally, the healing rate of the subscapularis repair was 93.1% (27 of 29) in the lesser tuberosity osteotomy group vs. 86.7% (26 of 30) in the subscapularis tenotomy group. Although the rate of healing was slightly higher in the lesser tuberosity osteotomy group, I wonder if these results would remain with a larger number of patients. Between these two groups, the healing rate was only different in a total of two patients. This difference is minimal, likely not showing true superiority of one over the other. My hope would be that Levine and colleagues continue to follow these patients over the next several years and publish their results. Does one group have better clinical outcomes and healing rates at 5 or 10 years? These are the quintessential questions that remain to be answered.

    • Christopher Kilian, MD
    • Shoulder and elbow surgeon
      Orthopaedic Associates of Wisconsin
      Pewaukee, WI

    Disclosures: Kilian reports he receives research support from Exactech.