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J Shoulder Elbow Surg. 2019 Mar;28(3):407-414. doi: 10.1016/j.jse.2018.11.057.

Subscapularis tenotomy versus lesser tuberosity osteotomy during total shoulder arthroplasty for primary osteoarthritis: a prospective, randomized controlled trial.

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Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopedic Surgery, Columbia University, New York, NY, USA. Electronic address:
Department of Orthopedic Surgery, University of Miami, Miami, FL, USA.
Department of Orthopedic Surgery, Northside Hospital Sports Medicine, Atlanta, GA, USA.
Department of Orthopaedic Surgery, Bone and Joint Institute of Tennessee, Franklin, TN, USA.
Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopedic Surgery, Columbia University, New York, NY, USA.
Department of Orthopaedics, Faculty of Medicine, Srinakarinwirot University, Nakhon Nayok, Thailand.



There is no current consensus on subscapularis mobilization during total shoulder arthroplasty. The purpose of this prospective, randomized controlled trial was to compare functional and radiographic outcomes of the more traditional subscapularis tenotomy (ST) versus lesser tuberosity osteotomy (LTO).


This study enrolled 60 shoulders in 59 patients with primary osteoarthritis. Thirty shoulders were preoperatively randomized to each group. Preoperative and 6-week, 3-month, 6-month, and 1-year postoperative data were collected. Ultrasound was performed at 3 months to evaluate subscapularis healing in tenotomy subjects, whereas radiographs were used to evaluate osteotomy healing. Intraoperative data included operative time, tenotomy or osteotomy repair time, and osteotomy thickness.


No significant differences in range of motion or clinical outcomes occurred at baseline or 1 year postoperatively between the 2 groups. The mean total case duration for ST was significantly less than that for LTO (129.3 minutes vs 152.7 minutes), along with a significantly shorter subscapularis repair time for ST (34.3 minutes vs 39.3 minutes, P = .024). At final follow-up, 27 of 29 LTO shoulders (93.1%) showed bone-to-bone healing on radiographs, whereas 26 of 30 ST shoulders (86.7%) had no full-thickness tear of the subscapularis on ultrasound at 3 months.


Both techniques produced successful objective and subjective clinical outcomes. LTO heals more reliably than ST. Mean total case and subscapularis repair times were significantly greater for LTO than for ST.


Lesser tuberosity osteotomy; anatomic TSA; anatomic total shoulder arthroplasty; subscapularis management; subscapularis tenotomy; total shoulder replacement

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