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Tomasz Poboży

Subscapularis Repair During Reverse Shoulder Arthroplasty — Is It Worthwhile?

Autor:

Tomasz Poboży

Polish version: Czy warto naprawiać ścięgno podłopatkowe podczas odwróconej endoprotezoplastyki barku?

Should the subscapularis insertion be restored by repairing a lesser tuberosity osteotomy during primary reverse shoulder arthroplasty? A randomised trial in The Journal of Bone and Joint Surgery supports repair, at least when the tendon is of sufficient quality for reattachment.

Why does this study matter?

Management of the subscapularis during reverse total shoulder arthroplasty remains debated. Earlier evidence was heterogeneous, and some recommendations relied on observational studies using different implant designs. This study was prospective and randomised, with at least two years of follow-up.

Research question and methods

The study was conducted at Washington University in St. Louis. Patients undergoing primary reverse total shoulder arthroplasty (rTSA) with a sufficiently preserved subscapularis tendon were randomised to repair or no repair of the lesser tuberosity osteotomy (LTO), to which the tendon remained attached.

The analysis at a minimum of two years included 85 shoulders in 81 patients; 43 shoulders were assigned to repair. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Range of motion, imaging and functional internal rotation were also assessed.

Main findings

  • At two years, the mean ASES score was higher after repair: 90.4 versus 82.3 (p = 0.01).
  • Repair was associated with approximately sevenfold greater odds of improved internal rotation.
  • No significant differences were found in other active ranges of motion or the other outcome scores assessed.

Clinical interpretation for an orthopaedic surgeon

In patients undergoing primary rTSA with a repairable subscapularis, LTO repair may improve overall function and internal rotation without a clear adverse effect on movement in other planes. This is particularly relevant to activities requiring the hand to reach behind the back.

Limitations

  • This was a single-centre study.
  • The sample was relatively small.
  • Only patients with a subscapularis suitable for reattachment were included.
  • The findings should not automatically be generalised to every implant design or clinical setting.

Implications for practice

The trial strengthens the case for preserving and repairing the subscapularis during primary reverse shoulder arthroplasty when anatomy and operative conditions allow. It does not establish that repair is necessary for every patient or that it has the same effect with all implants.

References

Aleem AW, Zmistowski BM, Sefko J, Chen L, Keener JD. The Impact of Lesser Tuberosity Osteotomy Repair After Reverse Total Shoulder Arthroplasty: A Randomized Controlled Trial. J Bone Joint Surg Am. 2026; online ahead of print. DOI: 10.2106/JBJS.25.01330. PMID: 42550892.

This summary is based on the publicly available abstract and publication metadata.

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For Doctors and Physiotherapists · Research Updates, Literature and Evidence-Based Medicine

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

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