Lesser Tuberosity Osteotomy Versus Soft-Tissue Subscapularis Release in Shoulder Arthroplasty: A Systematic Review. Issue 2 (June 2015)

• Record Type: Journal Article
• Authors: Cagle, Paul J.; Patton, Jason G.; Beck, Ryan T.; Braman, Jonathan
• Is Part Of: Techniques in shoulder & elbow surgery. Volume 16:Issue 2(2015)
• Publication Date: 2015-06
• Subjects: shoulder arthroplasty -- subscapularis -- lesser tuberosity osteotomy -- subscapularis tenotomy -- subscapularis repair; Shoulder -- Surgery -- Periodicals; Elbow -- Surgery -- Periodicals; 617
• DOI: 10.1097/BTE.0000000000000050
• Languages: English
• ISSNs: 1523-9896

Abstract

Abstract : Shoulder arthroplasty procedures continued to increase in prevalence, and controversy still remains about the optimal method to manage the subscapularis. Our study reviewed the available literature clinically comparing subscapularis approaches. A systematic review was conducted using MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials. All clinical trials were identified, and trials comparing at least 2 different subscapularis approaches were examined. Six clinical trials were identified comparing lesser tuberosity osteotomy, subscapularis tenotomy, and peel. Two were randomized-controlled trials comparing osteotomy and peel. Both trials demonstrated improvements in both the groups without demonstrating a significant advantage to either approach. Four trials retrospective analyzed subscapularis osteotomy compared with tenotomy. These trials demonstrate a tendency for improved clinical function with subscapularis osteotomy when patients perform a belly-press test or shirt tuck. Level I and II studies have not shown a significant difference between soft-tissue and bony subscapularis approach with shoulder arthroplasty, but retrospective studies have suggested improved clinical outcomes with osteotomy. Level of evidence: Level IV systematic review of level III and IV studies.