Lesser Tuberosity Osteotomy With Cerclage Wire Repair for Total Shoulder Arthroplasty: Surgical Technique

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Abstract

Total shoulder arthroplasty has been widely accepted as an effective treatment for patients suffering from primary glenohumeral osteoarthritis. The traditional deltopectoral approach involves mobilization of the subscapularis tendon by tenotomy, followed by a soft-tissue repair of the tendon. The high prevalence of subscapularis dysfunction after total shoulder arthroplasty has stimulated much interest in alternative techniques for mobilizing the subscapularis tendon. There has been a recent shift toward using a lesser tuberosity osteotomy (LTO) during the deltopectoral approach to the glenohumeral joint. Reports indicate that this method enhances glenoid exposure, provides a stronger repair with desirable bone-to-bone healing, can be easily monitored radiographically, and results in lower rates of subscapularis dysfunction postoperatively. Previously described LTO techniques primarily involve suture repair in parallel rows of bone tunnels drilled along the medial and lateral borders of the osteotomy site. The current study describes a modified technique and early results for LTO repair, minimizing the number of drill holes by the use of cerclage wire fixation.

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