title: Lift-off Test Results After Lesser Tuberosity Osteotomy Versus Subscapularis Peel in Primary Total Shoulder Arthroplasty.
abstract: BACKGROUND
  The ideal method for management of the subscapularis tendon during anatomic total shoulder arthroplasty (TSA) remains controversial.
  
  
  METHODS
  In a retrospective cohort study, primary anatomic TSA procedures performed with either a subscapularis peel or a lesser tuberosity osteotomy from 2002 to 2010 were reviewed at a minimum 1-year follow-up. The primary outcome measure was the performance of a normal lift-off test postoperatively. Multivariate logistic regression analysis was performed to determine if other covariates besides surgical technique correlated with an abnormal lift-off test result.
  
  
  RESULTS
  Ninety TSA procedures were evaluated. Forty-six procedures were performed with subscapularis peel, and 44 were performed with lesser tuberosity osteotomy. Mean follow-up was 4 years. In the subscapularis peel group, 32 of 46 shoulders (69.6%) had a normal lift-off test, compared with 40 of 44 shoulders (90.9%) in the lesser tuberosity osteotomy group (P = 0.01). The results of multivariate logistic regression suggested that lesser tuberosity osteotomy was associated with a normal postoperative lift-off test 4.5 times more often than was subscapularis peel.
  
  
  CONCLUSIONS
  Our study suggests that the use of lesser tuberosity osteotomy as the surgical approach for anatomic TSA is a reliable option that provides the patient with a better chance of maintaining subscapularis function postoperatively than the subscapularis peel does.
  
  
  METHODS
  Level III retrospective cohort study.
authors.affiliation: From the Department of Orthopaedics and Rehabilitation, University of Vermont Larner College of Medicine, Burlington, VT.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Shafritz
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fitzgerald
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Beynnon
authors.forename: Michael J
authors.initials: MJ
authors.lastname: DeSarno
mesh_terms: D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D011884:Radius / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome