The V-shaped subscapularis tenotomy for anatomic total shoulder arthroplasty
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ORIGINAL PAPER
The V-shaped subscapularis tenotomy for anatomic total shoulder arthroplasty Daniel J. H. Henderson 1,2 Laurent Lafosse 1
&
Thomas J. Christensen 1,3 & Austin Vo 1,4 & Johannes E. Plath 1,5 & Ion-Andrei Popescu 1,6 &
Received: 12 June 2020 / Accepted: 9 November 2020 # SICOT aisbl 2020
Abstract Purpose Management of the subscapularis tendon during anatomic total shoulder arthroplasty (TSA) remains controversial. In our unit, subscapularis tenotomy is the preferred technique; however, the potential for tendon gapping and failure is recognised. The purpose of this study is to describe and provide early clinical results of a novel, laterally based V-shaped tenotomy (VT) technique hypothesised to provide greater initial repair strength and resistance to gapping than a transverse tenotomy (TT), with both clinically and radiologically satisfactory post-operative tendon healing and function. Methods A retrospective study of patients who underwent primary TSA with VT over a three year period was performed using shoulder and subscapularis-specific outcome scores, radiographs, and ultrasound. A separate cohort of patients who underwent TSA using a subscapularis sparing approach was also reviewed to provide comparative clinical outcomes of a group with TSA and an un-violated subscapularis. Results Eighteen patients were reviewed at mean 30.4 months (± 11.7). Constant (78.2 ± 12.3), UCLA (8.4 ± 1.5), pain VAS (2.3 ± 2.8), and strength in internal rotation were no different from the comparison group. Likewise, neither were the clinical outcomes of range-of-motion, belly-press, lift-off, and shirt-tuck tests. One patient (5.5%) was found to have a failed subscapularis repair on ultrasound. Conclusion VT during TSA appears to provide healing rates at least equal to those reported for TT, and not dissimilar from those of lesser tuberosity osteotomy. Clinical outcomes are comparable to reported results in the literature for alternative techniques, and not different from those observed here in a comparison cohort with TSA performed without violating the subscapularis tendon. VT therefore potentially offers a more effective and secure tendon repair than a traditional TT, with at least comparable clinical outcomes. Keywords Shoulder arthroplasty . Anatomical shoulder replacement . Subscapularis tenotomy . Subscapularis repair
All work carried out at: Alps Surgery Institute, Clinique Générale d’Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France * Daniel J. H. Henderson [email protected] 1
Alps Surgery Institute, Clinique Générale d’Annecy, 4 Chemin de la Tour la Reine, 74000 Annecy, France
2
Department of Trauma & Orthopaedics & Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK
3
Reno Orthopaedic Clinic, Reno, NV, USA
4
Austin & Monash Health, Melbourne, Australia
5
Department of Trauma, Orthopaedic, Plastic & Hand Surgery, Zentralklinikum, Augsburg, Augsburg, Germany
6
European Shoulder & Hand Unit, Bucharest, Romania
Introduction Anatomical total shoulder arthr
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