Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2019 | Research article

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

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

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2019

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

Ahmad CS, Wing D, Gardner TR, Levine WN, Bigliani LU. Biomechanical evaluation of subscapularis repair used during shoulder arthroplasty. J Shoulder Elbow Surg. 2007;16(3 Suppl):S59–64. https://doi.org/10.1016/j.jse.2006.09.002.CrossRefPubMed

Brems JJ. Complications of shoulder arthroplasty: infections, instability, and loosening. Instr Course Lect. 2002;51:29–39.PubMed

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(9):1309–17. https://doi.org/10.1016/j.jse.2013.12.009.CrossRef

Burkhart SS, Fischer SP, Nottage WM, Esch JC, Barber FA, Doctor D, Ferrier J. Tissue fixation security in transosseous rotator cuff repairs: a mechanical comparison of simple versus mattress sutures. The Journal of Arthroscopic & Related Surgery. 1996. https://doi.org/10.1016/S0749-8063(96)90174-7.CrossRef

Edwards TB, Boulahia A, Kempf JF, Boileau P, Nemoz C, Walch G. The influence of rotator cuff disease on the results of shoulder arthroplasty for primary osteoarthritis: results of a multicenter study. J Bone Joint Surg Am. 2002;84-A;(12):2240–8.CrossRef

Gerber C, Pennington SD, Yian EH, Pfirrmann CA, Werner CM, Zumstein MA. Lesser tuberosity osteotomy for total shoulder arthroplasty. Surgical technique. J Bone Joint Surg Am. 2006;88 Suppl 1 Pt 2:170–7. https://doi.org/10.2106/JBJS.F.00407.CrossRefPubMed

Gerber C, Yian EH, Pfirrmann CA, Zumstein MA, Werner CM. Subscapularis muscle function and structure after total shoulder replacement with lesser tuberosity osteotomy and repair. J Bone Joint Surg Am. 2005;87(8):1739–45. https://doi.org/10.2106/JBJS.D.02788.CrossRefPubMed

Giuseffi SA, Wongtriratanachai P, Omae H, Cil A, Zobitz ME, An K, et al. Biomechanical comparison of lesser tuberosity osteotomy versus subscapularis tenotomy in total shoulder arthroplasty. J Shoulder Elbow Surg. 2012;21(8):1087–95. https://doi.org/10.1016/j.jse.2011.07.008.CrossRefPubMed

Jackson JD, Cil A, Smith J, Steinmann SP. Integrity and function of the subscapularis after total shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19(7):1085–90. https://doi.org/10.1016/j.jse.2010.04.001.CrossRefPubMed

10.

Jandhyala S, Unnithan A, Hughes S, Hong T. Subscapularis tenotomy versus lesser tuberosity osteotomy during total shoulder replacement: a comparison of patient outcomes. J Shoulder Elbow Surg. 2011;20(7):1102–7. https://doi.org/10.1016/j.jse.2011.03.019.CrossRefPubMed

11.

Lapner PL, Sabri E, Rakhra K, Bell K, Athwal GS. Comparison of lesser tuberosity osteotomy to subscapularis peel in shoulder arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2012;94(24):2239–46. https://doi.org/10.2106/JBJS.K.01365.CrossRefPubMed

12.

Lederman E, Streit J, Idoine J, Shishani Y, Gobezie R. Biomechanical study of a subscapularis repair technique for total shoulder arthroplasty. Orthopedics. 2016;39(5):e937–43. https://doi.org/10.3928/01477447-20160623-09.CrossRefPubMed

13.

Levine WN, Munoz J, Hsu S, Byram IR, Bigliani LU, Ahmad CS, Kongmalai P, Shillingford JN. Subscapularis tenotomy versus lesser tuberosity osteotomy during total shoulder arthroplasty for primary osteoarthritis: a prospective, randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2019; 28(3):407–14.CrossRef

14.

Miller BS, Joseph TA, Noonan TJ, Horan MP, Hawkins RJ. Rupture of the subscapularis tendon after shoulder arthroplasty: diagnosis, treatment, and outcome. J Shoulder Elbow Surg. 2005;14(5):492–6. https://doi.org/10.1016/j.jse.2005.02.013.CrossRefPubMed

15.

Miller SL, Hazrati Y, Klepps S, Chiang A, Flatow EL. Loss of subscapularis function after total shoulder replacement: a seldom recognized problem. J Shoulder Elbow Surg. 2003;12(1):29–34. https://doi.org/10.1067/mse.2003.128195.CrossRefPubMed

16.

Moeckel BH, Altchek DW, Warren RF, Wickiewicz TL, Dines DM. Instability of the shoulder after arthroplasty. J Bone Joint Surg Am. 1993;75(4):492–7.CrossRef

17.

Ponce BA, Ahluwalia RS, Mazzocca AD, Gobezie RG, Warner JJ, Millett PJ. Biomechanical and clinical evaluation of a novel lesser tuberosity repair technique in total shoulder arthroplasty. J Bone Joint Surg Am. 2005;87(Suppl 2):1–8. https://doi.org/10.2106/JBJS.E.00441.CrossRefPubMed

18.

Qureshi S, Hsiao A, Klug RA, Lee E, Braman J, Flatow EL. Subscapularis function after total shoulder replacement: results with lesser tuberosity osteotomy. J Shoulder Elbow Surg. 2008;17(1):68–72. https://doi.org/10.1016/j.jse.2007.04.018.CrossRefPubMed

19.

Sanchez-Sotelo J. Subscapularis tenotomy in anatomic total shoulder arthroplasty. J Shoulder Elbow Surg. 2017;1:247154921774360. https://doi.org/10.1177/2471549217743605.CrossRef

20.

Scalise JJ, Ciccone J, Iannotti JP. Clinical, radiographic, and ultrasonographic comparison of subscapularis tenotomy and lesser tuberosity osteotomy for total shoulder arthroplasty. J Bone Joint Surg Am. 2010;92(7):1627–34. https://doi.org/10.2106/JBJS.G.01461.CrossRefPubMed

21.

Scheibel M, Habermeyer P. Subscapularis dysfunction following anterior surgical approaches to the shoulder. J Shoulder Elbow Surg. 2008;17(4):671–83. https://doi.org/10.1016/j.jse.2007.11.005.CrossRefPubMed

22.

Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93(11):1057–63. https://doi.org/10.2106/JBJS.J.00160.CrossRefPubMed

23.

Sperling JW, Potter HG, Craig EV, Flatow E, Warren RF. Magnetic resonance imaging of painful shoulder arthroplasty. J Shoulder Elbow Surg. 2002;11(4):315–21. https://doi.org/10.1067/mse.2002.124426.CrossRefPubMed

24.

Van den Berghe GR, Nguyen B, Patil S, D’Lima DD, Mahar A, Pedowitz R, et al. A biomechanical evaluation of three surgical techniques for subscapularis repair. J Shoulder Elbow Surg. 2008;17(1):156–61. https://doi.org/10.1016/j.jse.2007.04.016.CrossRefPubMed

25.

Van Thiel GS, Wang VM, Wang FC, Nho SJ, Piasacki DP, Bach BR, et al. Biomechanical similarities among subscapularis repairs after shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19(5):657–63. https://doi.org/10.1016/j.jse.2010.01.014.CrossRefPubMed

Title: Biomechanical comparison of subscapularis peel and lesser tuberosity osteotomy for double-row subscapularis repair technique in a cadaveric arthroplasty model
Authors: Mandeep S. Virk
Saleh S. Aiyash
Rachel M. Frank
Christopher S. Mellano
Elizabeth F. Shewman
Vincent M. Wang
Anthony A. Romeo
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2019
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-019-1372-x

ACC 2024 Congress

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusions

Level of evidence

ACC 2024 Congress

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 1/2019

The 10-year outcomes of the ASR XL Acetabular System: a single-center experience from China

Supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization for varus ankle osteoarthritis with excessive talar tilt angle

Plate-related results of opening wedge high tibial osteotomy with a carbon fiber reinforced poly-ether-ether-ketone (CF-PEEK) plate fixation: a retrospective case series of 346 knees

Supplementation of enteral nutritional powder decreases surgical site infection, prosthetic joint infection, and readmission after hip arthroplasty in geriatric femoral neck fracture with hypoalbuminemia

How to evaluate the clinical outcome of joint-preserving treatment for osteonecrosis of the femoral head: development of a core outcome set

RETRACTED ARTICLE: Effect of sagittal femoral component alignment on biomechanics after mobile-bearing total knee arthroplasty