Subscapularis Tenotomy in Anatomic Total Shoulder Arthroplasty

Abstract

[AQ2]Tenotomy of the subscapularis is commonly used for exposure at the time of anatomic total shoulder arthroplasty. Understanding the anatomy of the subscapularis and its footprint for insertion into the lesser tuberosity helps perform an adequate tenotomy. Incision of the tendon in the right place, release of the anterior capsule to restore excursion, a sound repair, and postoperative protection are important. Controversy remains regarding the relative advantages and disadvantages of tenotomy compared with alternatives, in particular osteotomy of the lesser tuberosity. Tenotomy has been associated with a higher rate of positive physical examination findings for subscapularis weakness and concerning tendon attenuation or rupture in some shoulders evaluated with ultrasound. However, patient-reported outcomes, objective measurement of strength in internal rotation, and revision and reoperation rates are identical with tenotomy and osteotomy. Tenotomy is particularly attractive in terms of simplicity, shorter operative time, and use in stemless shoulder arthroplasty. Failure of the tenotomy to heal leading to anterior instability can be salvaged surgically but oftentimes requires revision to a reverse arthroplasty.