Effect of lesser tuberosity osteotomy size and repair construct during total shoulder arthroplasty.
نویسندگان
چکیده
BACKGROUND Lesser tuberosity osteotomy has been shown to decrease postoperative subscapularis dysfunction. The purpose of this study was to determine the effect of osteotomy thickness and suture configuration on repair integrity. MATERIALS AND METHODS One side of 12 matched-pair cadaveric shoulders was randomly assigned to either a thick osteotomy (100% of lesser tuberosity height) or a thin osteotomy (50% of height). Both sides of the matched pairs were given the same repair, either (1) compression sutures or (2) compression sutures plus 1 tension suture. This created 4 groups of 6 paired specimens. Computed tomography imaging was used to measure tuberosity dimensions before and after osteotomy to validate fragment height and area. The repairs were loaded cyclically and then loaded to failure. A video system measured fragment displacement. The percent area of osteotomy contact was calculated from the computed tomography and displacement data. RESULTS The average initial displacement was less in the thin osteotomy groups (P = .011). Adding a tension suture negated this difference. A significant number of thin repair sites compared with thick repair sites remained intact during load-to-failure testing (P = .001). No difference occurred because of maximum load between the repair groups (P = .401), and construct stiffness was greater when a tension suture was used (P = .032). The percent area of osteotomy contact showed no differences between the osteotomy (P = .431) and repair (P = .251) groups. CONCLUSION The study showed that thin osteotomies displaced less than thick osteotomies. Adding a tension band improved construct stability and eliminated some failure modes. Our ideal repair was a thin wafer with both tension and compression sutures. This construct had smaller total displacement, a high osteotomy percent contact area, and a high maximum load.
منابع مشابه
Biomechanical similarities among subscapularis repairs after shoulder arthroplasty.
HYPOTHESIS Many authors suggest that subscapularis deficiency after shoulder arthroplasty has a negative effect on long-term outcomes. Thus, increasing emphasis has been placed on the technique for repair of the tendon. This study evaluated the biomechanical strength of 3 different repairs: osteotomy, tendon to bone, and a combined method. MATERIALS AND METHODS Twenty-four paired shoulders fr...
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Analysis of subscapularis integrity and function after lesser tuberosity osteotomy versus subscapularis tenotomy in total shoulder arthroplasty using ultrasound and validated clinical outcome measures.
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ورودعنوان ژورنال:
- Journal of shoulder and elbow surgery
دوره 23 1 شماره
صفحات -
تاریخ انتشار 2014