Lesser tuberosity osteotomy minimizes subscapularis insufficiency in shoulder replacement

Take down of the subscapularis tendon is a necessary step in performing total shoulder arthroplasty through the deltopectoral approach. Anatomic repair and healing of the subscapularis is vital to achieving reliable functional outcomes postoperatively. Detachment of the subscapularis is typically achieved by either tenotomy, subscapularis peel, or lesser tuberosity osteotomy. Previous reports have suggested that subscapularis dysfunction after either tenotomy or peel is remarkably high. It is our opinion that lesser tuberosity osteotomy is the preferred method of subscapularis take down during shoulder arthroplasty. Herein we review the literature comparing the various techniques of subscapularis management and discuss our preferred method for lesser tuberosity osteotomy during total shoulder arthroplasty via the standard deltopectoral approach.