Lesser tuberosity osteotomy versus soft-tissue subscapularis release in Shoulder arthroplasty: A systematic review

Shoulder arthroplasty procedures continued to increase in prevalence, and controversy still remains about the optimal method to manage the subscapularis. Our study reviewed the available literature clinically comparing subscapularis approaches. A systematic review was conducted using MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials. All clinical trials were identified, and trials comparing at least 2 different subscapularis approaches were examined. Six clinical trials were identified comparing lesser tuberosity osteotomy, subscapularis tenotomy, and peel. Two were randomized-controlled trials comparing osteotomy and peel. Both trials demonstrated improvements in both the groups without demonstrating a significant advantage to either approach. Four trials retrospective analyzed subscapularis osteotomy compared with tenotomy. These trials demonstrate a tendency for improved clinical function with subscapularis osteotomy when patients perform a belly-press test or shirt tuck. Level I and II studies have not shown a significant difference between soft-tissue and bony subscapularis approach with shoulder arthroplasty, but retrospective studies have suggested improved clinical outcomes with osteotomy.