Subscapularis tenotomy vs. lesser tuberosity osteotomy during total shoulder arthroplasty: When less is more

Mobilization of the subscapularis is necessary during total shoulder arthroplasty, but high rates of subscapularis dysfunction have been reported postoperatively. Two methods are commonly used: subscapularis tenotomy with tendon-to-tendon repair and lesser tuberosity osteotomy with bone-to-bone repair. There is conflicting data as to which of these methods provides superior results. This article reviews the literature to date and provides the preliminary results from a prospective randomized controlled trial comparing subscapularis tenotomy to lesser tuberosity osteotomy. Our results show that lesser tuberosity osteotomy and subscapularis tenotomy both provide a reliable, consistent healing method for subscapularis management with comparably excellent outcomes.