Several different techniques have been described for repairing a lesser tuberosity osteotomy in shoulder arthroplasty, although all have potential drawbacks. We describe a novel repair technique and its radiological results.
Methods
All patients undergoing a total shoulder arthroplasty using a resurfacing humeral component from 2008 to date were identified retrospectively. Anteroposterior (AP) and axial radiographs at a minimum of 3 months postoperatively were used to assess union of the osteotomy fragment.
Results
Seventy-six total shoulder replacements in 65 patients were eligible for review. Seven were excluded as a result of inadequate radiographs. Sixty-six of 69 had united (95.6%). There were two cases (2.9%) of a complete non-union that was undisplaced. In one patient (1.4%), the osteotomy fragment had displaced and this was apparent on the initial postoperative AP radiograph.
Conclusions
The modified union jack repair technique is simple, fast, economical and reliable.
GerberC., YianEH, PfirrmannCA, ZumsteinMA, WernerCM. Subscapularis muscle function and structure after total shoulder replacement with lesser tuberosity osteotomy and repair.J Bone Joint Surg Am2005; 87: 1739-45.
2.
GerberC., PenningtonSD, YianEH, PfirrmannCA, WernerCM, ZumsteinMA. Lesser tuberosity osteotomy for total shoulder arthroplasty. Surgical technique.J Bone Joint Surg Am2006; 88(Suppl 1) Pt 2: 170-7.
3.
De WildeLF, De ConinckT., De NeveF., BerghsBM. Subscapularis release in shoulder replacement determines structural muscular changes.Clin Orthop Relat Res2012; 470: 2193-201.
4.
KrishnanSG, StewartDG, ReineckJR, LinKC, BuzzellJE, BurkheadWZ. Subscapularis repair after shoulder arthroplasty: biomechanical and clinical validation of a novel technique.J Shoulder Elbow Surg2009; 18: 184-92; discussion 197–198.
5.
PonceBA, AhluwaliaRS, MazzoccaAD, GobezieRG, WarnerJJ, MillettPJ. Biomechanical and clinical evaluation of a novel lesser tuberosity repair technique in total shoulder arthroplasty.J Bone Joint Surg Am2005; 87(Suppl 2): 1-8.
6.
DefrancoMJ, HigginsLD, WarnerJJ. Subscapularis management in open shoulder surgery.J Am Acad Orthop Surg2010; 18: 707-17.
7.
ArmstrongA., LashgariC., TeefeyS., MenendezJ., YamaguchiK., GalatzLM. Ultrasound evaluation and clinical correlation of subscapularis repair after total shoulder arthroplasty.J Shoulder Elbow Surg2006; 15: 541-8.
8.
MillerSL, HazratiY., KleppsS., ChiangA., FlatowEL. Loss of subscapularis function after total shoulder replacement: a seldom recognized problem.J Shoulder Elbow Surg2003; 12: 29-34.
9.
MillerBS, JosephTA, NoonanTJ, HoranMP, HawkinsRJ. Rupture of the subscapularis tendon after shoulder arthroplasty: diagnosis, treatment, and outcome.J Shoulder Elbow Surg2005; 14: 492-6.
10.
GiuseffiSA, WongtriratanachaiP., OmaeH.. Biomechanical comparison of lesser tuberosity osteotomy versus subscapularis tenotomy in total shoulder arthroplasty.J Shoulder Elbow Surg2012; 21: 1087-95.
11.
Van den BergheGR, NguyenB., PatilS.. A biomechanical evaluation of three surgical techniques for subscapularis repair.J Shoulder Elbow Surg2008; 17: 156-61.
12.
Van ThielGS, WangVM, WangFC. Biomechanical similarities among subscapularis repairs after shoulder arthroplasty.J Shoulder Elbow Surg2010; 19: 657-63.
13.
JandhyalaS., UnnithanA., HughesS., HongT. Subscapularis tenotomy versus lesser tuberosity osteotomy during total shoulder replacement: a comparison of patient outcomes.J Shoulder Elbow Surg2011; 20: 1102-7.
14.
QureshiS., HsiaoA., KlugRA, LeeE., BramanJ., FlatowEL. Subscapularis function after total shoulder replacement: results with lesser tuberosity osteotomy.J Shoulder Elbow Surg2008; 17: 68-72.
15.
LevyJC, KalandiakS. Radiographic appearance of displaced lesser tuberosity osteotomy: a case series.J Shoulder Elbow Surg2011; 20: 395-400.
16.
LapnerPL, SabriE., RakhraK., BellK., AthwalGS. Healing rates and subscapularis fatty infiltration after lesser tuberosity osteotomy versus subscapularis peel for exposure during shoulder arthroplasty.J Shoulder Elbow Surg2013; 22: 396-402.
17.
LapnerPL, SabriE., RakhraK., BellK., AthwalGS. Comparison of lesser tuberosity osteotomy to subscapularis peel in shoulder arthroplasty: a randomized controlled trial.J Bone Joint Surg Am2012; 94: 2239-46.
18.
JacksonJD, CilA., SmithJ., SteinmannSP. Integrity and function of the subscapularis after total shoulder arthroplasty.J Shoulder Elbow Surg2010; 19: 1085-90.
19.
ScheibelM., HabermeyerP. Subscapularis dysfunction following anterior surgical approaches to the shoulder.J Shoulder Elbow Surg2008; 17: 671-83.
20.
LiemD., KleeschulteK., DedyN., SchulteTL, SteinbeckJ., MarquardtB. Subscapularis function after transosseous repair in shoulder arthroplasty: transosseous subscapularis repair in shoulder arthroplasty.J Shoulder Elbow Surg2012; 21: 1322-7.
21.
ScaliseJJ, CicconeJ., IannottiJP. Clinical, radiographic, and ultrasonographic comparison of subscapularis tenotomy and lesser tuberosity osteotomy for total shoulder arthroplasty.J Bone Joint Surg Am2010; 92: 1627-34.
22.
HeckmanDS, HooverSA, WeinholdPS, SpangJT, CreightonRA. Repair of lesser tuberosity osteotomy for shoulder arthroplasty: biomechanical evaluation of the Backpack and Dual Row techniques.J Shoulder Elbow Surg2011; 20: 491-6.
