Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Feb 1;2(1):8-12.
doi: 10.1016/j.jses.2017.11.008. eCollection 2018 Mar.

A biomechanical comparison of subscapularis repair techniques in total shoulder arthroplasty: lesser tuberosity osteotomy versus subscapularis peel

Morenikeji Ayodele Buraimoh  1 , Kelechi R Okoroha  1 , Daniel J Oravec  2 , Cathryn D Peltz  2 , Yener N Yeni  2 , Stephanie J Muh  1
Affiliations

A biomechanical comparison of subscapularis repair techniques in total shoulder arthroplasty: lesser tuberosity osteotomy versus subscapularis peel

Morenikeji Ayodele Buraimoh et al. JSES Open Access. .

Abstract

Background: The subscapularis peel (SP) and the lesser tuberosity osteotomy (LTO) are 2 common exposure techniques for total shoulder arthroplasty. Although some biomechanical studies have suggested a higher resistance to failure with the LTO, clinical studies have demonstrated no difference in repair failure or tendon healing. We hypothesized that there would be no difference in biomechanically tested repair strength between our SP technique and the previously tested LTO technique.

Methods: Eleven cadaver shoulders were separated into 2 groups: 6 SPs and 5 LTOs. After initial loading for 3000 cycles, the specimens were incrementally loaded to 450 ± 50 N or catastrophic failure. Repair gapping was measured after cyclical loading, and fatigue life was analyzed after incremental loading.

Results: There was no significant difference in mean repair gapping between the SP (2.40 ± 0.36 mm; mean ± standard deviation) and the LTO groups (3.10 ± 2.93 mm; P = .57). There was also no difference in the mean number of cycles to failure (6894 ± 956 vs. 6018 ± 1179; P = .14) and mean load to failure (400 ± 79 N vs. 340 ± 91 N; P = .21) between the SP and LTO techniques. However, there was more variability in bead gapping in the LTO group (P < .01).

Conclusion: No significant differences were found in repair gapping, fatigue failure, and load to failure in comparing the SP and LTO repairs. However, the SP repair demonstrated significantly less variability in repair gapping. These findings suggest that initial fixation biomechanical properties between the 2 constructs are similar in vitro.

Keywords: Biomechanics; Lesser tuberosity osteotomy; Shoulder arthritis; Subscapularis peel; Subscapularis takedown; Total shoulder arthroplasty.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Sketch of the lesser tuberosity osteotomy repair technique featuring the horizontal mattress backpack suture repair with a one-third tubular plate.
Figure 2
Figure 2
Sketch of subscapularis peel repair featuring medial and lateral drill holes around the lesser tuberosity and a modified Mason-Allen suture pattern in the tendon.
Figure 3
Figure 3
Photograph illustration of lesser tuberosity osteotomy repair and material testing system setup.
Figure 4
Figure 4
Photograph illustration of subscapularis peel repair and material testing system setup.
Figure 5
Figure 5
Mean repair gapping after cyclical loading. Although mean gapping did not differ, there was a wider range of repair gapping for the lesser tuberosity osteotomy (LTO) group. The error bars show standard deviations. SP, subscapularis peel.
See this image and copyright information in PMC

References

    1. Ahmad C.S., Wing D., Gardner T.R., Levine W.N., Bigliani L.U. Biomechanical evaluation of subscapularis repair used during shoulder arthroplasty. J Shoulder Elbow Surg. 2007;16:S59–S64. doi: 10.1016/j.jse.2006.09.002. - DOI - PubMed
    1. Buckley T., Miller R., Nicandri G., Lewis R., Voloshin I. Analysis of subscapularis integrity and function after lesser tuberosity osteotomy versus subscapularis tenotomy in total shoulder arthroplasty using ultrasound and validated clinical outcome measures. J Shoulder Elbow Surg. 2014;23:1309–1317. doi: 10.1016/j.jse.2013.12.009. - DOI - PubMed
    1. Burkhart S.S., Johnson T.C., Wirth M.A., Athanasiou K.A. Cyclic loading of transosseous rotator cuff repairs: tension overload as a possible cause of failure. Arthroscopy. 1997;13:172–176. - PubMed
    1. Defranco M.J., Higgins L.D., Warner J.J. Subscapularis management in open shoulder surgery. J Am Acad Orthop Surg. 2010;18:707–717. - PubMed
    1. Gerber C., Pennington S.D., Yian E.H., Pfirrmann C.A., Werner C.M., Zumstein M.A. Lesser tuberosity osteotomy for total shoulder arthroplasty. Surgical technique. J Bone Joint Surg Am. 2006;88:170–177. doi: 10.2106/JBJS.F.00407. - DOI - PubMed

LinkOut - more resources