The Impact of Lesser Tuberosity Osteotomy Repair After Reverse Total Shoulder Arthroplasty: A Randomized Controlled Trial.

Abstract

Although reverse total shoulder arthroplasty (rTSA) is widely used to treat a variety of complex shoulder pathologies, the management of the subscapularis tendon during rTSA remains controversial. The aim of this study was to prospectively compare outcomes following rTSA with and without lesser tuberosity repair for subscapularis management. This patient-blinded randomized controlled trial, conducted at a single institution, enrolled patients with a sufficiently intact subscapularis suitable for reattachment. Patients were randomized to either repair or no repair of the lesser tuberosity osteotomy (LTO) fragment to which the subscapularis was attached. Pre- and postoperative assessments involved radiographs, clinical examinations, and patient-reported outcomes, including a validated internal rotation functional score. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Eighty-five shoulders in 81 patients met the inclusion criteria and had at least 2 years of follow-up. Forty-three of these shoulders had been randomized to LTO repair. At 2 years of follow-up, the repair group demonstrated significantly better ASES scores compared with the no-repair group (90.4 versus 82.3, p = 0.01). Repair provided 7 times better odds of achieving improved internal rotation range of motion. There were no significant differences in other active shoulder motions or outcome scores. In primary rTSA, subscapularis reattachment (by repair of the LTO) yielded better functional outcomes and internal rotation range of motion, as well as a trend toward a better internal rotation functional score. These benefits were seen without sacrificing shoulder motion in other planes. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.