Clinical and functional outcomes for bone tunnel vs. suture anchor lesser tuberosity osteotomy repair in total shoulder arthroplasty

Abstract

Background Subscapularis management with lesser tuberosity osteotomy (LTO) repair in stemless total shoulder arthroplasty (TSA) is particularly different in terms of suture fixation as opposed to stemmed humeral implants. Surgical techniques to achieve optimal soft tissue balance in LTO repairs differ based on the surgeon. The purpose of this study is to determine whether there is a difference in 2 years functional or clinical outcomes in stemless TSA patients treated with LTO repairs conducted with bone tunnels versus suture anchors. Methods A retrospective review was performed of a prospectively maintained, multicenter database of primary TSAs performed by multiple surgeons between 2019 and 2023 with minimum 2-year follow-up. A total of 81 patients met the study criteria, including 33 in the suture anchor cohort versus 48 in the bone tunnel cohort. Patient-reported outcomes (PROs) as well as range of motion (ROM) measurements were compared between the 2 groups for baseline results as well as at two year follow-up. Results There was no statistically significant difference in age, sex, body mass index, tobacco usage, or diabetes prevalence in either cohort (P = .610, P = .687, P = .980), P = .153, P = .355, respectively). There was no statistically significant difference in PRO, ROM, or belly press test at baseline between patients treated with suture anchors and those treated with bone tunnels. At two years, there were no statistical differences in outcomes (PROs, ROM, or strength), other than worse forward flexion in the suture anchor group (145° vs. 156°, P = .026). Conclusion The current study suggests equivalent two year functional and clinical outcomes for patients treated with suture anchors versus the conventional bone tunnels in LTO repair for stemless TSA patients. The 2 groups had similar baseline demographics, ROM, and PRO scores and performed similarly at two years follow-up.