Biomechanical comparison of subscapularis peel and lesser tuberosity osteotomy for double-row subscapularis repair techn
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(2019) 14:391
RESEARCH ARTICLE
Open Access
Biomechanical comparison of subscapularis peel and lesser tuberosity osteotomy for double-row subscapularis repair technique in a cadaveric arthroplasty model Mandeep S. Virk1†, Saleh S. Aiyash2†, Rachel M. Frank2, Christopher S. Mellano2, Elizabeth F. Shewman2, Vincent M. Wang2 and Anthony A. Romeo3*
Abstract Introduction: Management of the subscapularis during shoulder arthroplasty is controversial. The purpose of this study was to compare the biomechanical performance of subscapularis peel (SP) and lesser tuberosity osteotomy (LTO) in a cadaveric model. Methods: The subscapularis and proximal humerus were dissected from all soft tissues in 21 fresh-frozen human cadaveric shoulders and randomized to undergo SP, LTO, or standard subscapularis tenotomy (ST, control). For SP and LTO, six #5 sutures were passed through eyelets in the implant (on lateral border and through drill holes in bicipital groove [2] and under trunion [4]). Double-row repair was performed using two lateral row transosseous sutures and four medial row sutures through the tendon (SP) or osseotendinous junction (LTO). Biomechanical properties and mode of failure were tested. Results: There were no significant differences in elongation amplitude, cyclic elongation, or maximum load to failure between the three groups (P > 0.05). Mean stiffness was significantly higher in LTO (P = 0.009 vs. SP and ST). In the ST group, 7/7 specimens failed at the tendon-suture interface. For SP, 4/7 failed at the tendon-suture interface, one at the suture-bone interface, one fractured around the implant stem, and one at the knots. For LTO, 3/7 failed at the tendon-suture interface, two at the suture-bone interface and two fractured around the implant stem. Conclusions: In this cadaveric model, subscapularis repair via ST, SP, and LTO techniques was biomechanically equivalent. Additional studies are needed to confirm these findings and determine the influence of biologic healing on healing rates and clinical outcomes. Level of evidence: N/a, biomechanical laboratory study Keywords: Total shoulder arthroplasty, Biomechanical analysis, Subscapularis tenotomy, Subscapularis peel, Lesser tuberosity osteotomy, Subscapularis failure
* Correspondence: [email protected] † Mandeep S. Virk and Saleh S. Aiyash are co-first authors. 3 Rothman Orthopaedics- New York, 176 3rd Ave, New York, NY 10003, USA Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made
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