Background
Subscapularis dysfunc
tion following
to
tal shoulder ar
throplas
ty can resul
t in permanen
t loss of func
tion. The lesser
tuberosi
ty os
teo
tomy (LTO) has been proposed as a me
thod which u
tilizes bone-
to-bone healing
to improve subscapularis func
tion. This s
tudy evalua
tes
the biomechanical proper
ties of
two described
techniques for LTO repair. We hypo
thesized
tha
t a Dual Row repair would be s
tronger and demons
tra
te less cyclic displacemen
t than a Backpack repair.
Materials and methods
Ten matched pairs of cadaveric humeri were dissected, leaving the subscapularis intact, and a lesser tuberosity osteotomy was performed. Matched shoulders were randomized to either a Backpack repair or a Dual Row repair. Repairs were subjected to cyclic loading to 180 N for 500 cycles, followed by ramp-up loading to ultimate failure. Clinical failure was defined as displacement >5 mm after 500 cycles.
Results
Displacement after 500 cycles was significantly greater for the Backpack repair (6.9 mm) than for the Dual Row repair (4.6 mm) (P = .007). Most displacement occurred on the first cycle (Backpack, 4.6 mm; Dual Row, 2.1mm) (P < .001). There was a trend toward a higher clinical failure rate for the Backpack repair (8/10) than the Dual Row repair (3/10). Ultimate tensile strength was significantly greater for the Dual Row repair (632.3 N) than for the Backpack repair (510.9 N) (P = .01).
Conclusion
The Dual Row technique is significantly stronger and demonstrates less cyclic displacement than the Backpack technique. Clinical studies are needed to determine the impact of LTO repair technique on subscapularis function following shoulder arthroplasty.