Outcomes of Transosseous Suture-Cable Repair for Lesser Tuberosity Osteotomy in Stemless Anatomic Total Shoulder Arthroplasty: A Retrospective Case Series.

Abstract

Stemless anatomic total shoulder arthroplasty (aTSA) has gained considerable traction as an alternative to traditional stemmed implants for the management of glenohumeral arthritis, particularly for patients where bone preservation is a priority. However, some surgeons remain cautious employing a lesser tuberosity osteotomy (LTO) when using stemless implants due to concerns of metaphyseal fixation and implant stability. This study evaluates clinical, radiographic, and functional outcomes of a novel transosseous suture-cable repair for LTO in stemless aTSA. A retrospective review identified 55 stemless aTSAs performed in fifty-two patients by a single surgeon from September 2022 to September 2024. Patients ≥18 years old who underwent stemless aTSA with LTO were included, while revisions or patients with prior metal hardware were excluded. All patients underwent a transosseous suture-cable LTO repair anchored to the bicipital groove. Patient charts were reviewed to assess clinical, radiographic, and patient-reported outcomes. Radiographic LTO healing was classified as fully healed, partially healed, or not healed, and reoperation and implant-related complications were assessed. Functional outcomes included American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores. Pain was evaluated using the visual analog scale (VAS). Range of motion (ROM) was measured for abduction, forward flexion, external rotation, and internal rotation (IR) preoperatively and at final follow-up. At the latest follow-up, 87.3% (n=48) of LTOs demonstrated full bony healing, 10.9% (n=6) were partially healed, and 1.8% (n=1) did not heal. Follow-up time for this study was 26.7 ± 8.3 months. No implant loosening or malposition was observed. There were no reoperations. Postoperatively, glenohumeral abduction improved from 58.6° ± 28.7° to 104.5° ± 49.8° (p<0.001), forward flexion from 110.0° ± 27.0° to 149.3° ± 33.6° (p<0.001), and external rotation from 17.8° ± 18.3° to 50.4° ± 16.4° (p<0.001). Of the patients with "poor" IR, approximately 22% (7/32) improved to "acceptable" or "normal" IR (p=0.027). Mean postoperative ASES and SANE scores were 94.0 ± 7.4 and 88.2 ± 9.2, respectively, with a mean VAS pain score of 0.1 ± 0.6. Transosseous suture-cable fixation for LTO in stemless aTSA achieves high healing rates, excellent functional outcomes, and minimal complications. Patients showed significant improvements in pain, motion, and internal rotation, supporting the role of LTO in preserving subscapularis function.