Lapner, J Shoulder Elbow Surg 2013 - Healing Rates and Subscapularis Fatty Infiltration after Lesser Tuberosity Osteotomy versus Subscapularis Peel for Exposure during Shoulder Arthroplasty - Article Summary

Healing Rates and Subscapularis Fatty Infiltration after Lesser Tuberosity Osteotomy versus Subscapularis Peel for Exposure during Shoulder Arthroplasty

Lapner, Athwal, et al.·J Shoulder Elbow Surg·2013·89 citations·RCT

Background

Controversy exists regarding the optimal technique of subscapularis mobilization during shoulder arthroplasty. The purpose of this study was to compare healing rates and subscapularis fatty infiltration in patients undergoing a lesser tuberosity osteotomy (LTO) versus subscapularis peel for exposure during shoulder arthroplasty.

Methods

87 patients, with a mean age of 67.8 ± 10.9 years, undergoing shoulder arthroplasty, were randomized to receive either an LTO (n = 43) or peel (n = 44).
Computed tomography scans were conducted preoperatively and at 12 months postoperatively.
Outcome variables included healing rates and subscapularis Goutallier fatty infiltration grade, as well as subscapularis strength and Western Ontario Osteoarthritis of the Shoulder Index and American Shoulder and Elbow Surgeons outcome scores.

Results

Computed tomography imaging was available in 91% (n = 79) of the cohort.
The healing rates for the peel (100%) and for the LTO (95%) did not differ significantly (P = .493).
Preoperatively, the mean fatty infiltration grade for the peel (mean, 0.53) was not significantly different (P = .925) from the LTO (mean, 0.54).
Postoperatively, the Goutallier mean fatty infiltration grade for the peel (mean, 0.95) did not differ significantly (P = .803) from the LTO (mean, 0.9).
A significant increase in subscapularis fatty infiltration grade occurred postoperatively from the preoperative status (peel, P = .003; LTO, P = .0002).
No statistically significant associations were observed between postoperative fatty infiltration grades and subscapularis strength, Western Ontario Osteoarthritis of the Shoulder Index scores, or American Shoulder and Elbow Surgeons scores.

Conclusions

Discussion: No statistically significant differences were observed in the healing rates or subscapularis fatty infiltration grades between the peel and the LTO. This trial does not show any clear difference in radiologic and clinical outcomes of one subscapularis management technique over the other.

Supplemental

Healing Rates and Subscapularis Fatty Infiltration after Lesser Tuberosity Osteotomy versus Subscapularis Peel for Exposure during Shoulder Arthroplasty

Lapner, Athwal, et al.J Shoulder Elbow Surg201389 citationsRCT