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01-01-2021 | Original Paper

The V-shaped subscapularis tenotomy for anatomic total shoulder arthroplasty

Authors: Daniel J. H. Henderson, Thomas J. Christensen, Austin Vo, Johannes E. Plath, Ion-Andrei Popescu, Laurent Lafosse

Published in: International Orthopaedics | Issue 1/2021

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.

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Title: The V-shaped subscapularis tenotomy for anatomic total shoulder arthroplasty
Authors: Daniel J. H. Henderson
Thomas J. Christensen
Austin Vo
Johannes E. Plath
Ion-Andrei Popescu
Laurent Lafosse
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 1/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04880-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The V-shaped subscapularis tenotomy for anatomic total shoulder arthroplasty

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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