Subscapularis handling in anatomical shoulder arthroplasty

Anatomical shoulder arthroplasty is a reliable method used to alleviate pain and improve function in patients with glenohumeral arthritis. Recent research has focused on the handling of the subscapularis during anatomical shoulder arthroplasty. Four different approaches have been described: subscapularis tenotomy, subscapularis tendon peel, lesser tuberosity osteotomy, or a subscapularis preserving technique. In the literature, lesser tuberosity osteotomy shows better biomechanical and clinical results compared with subscapularis tenotomy. Two surgical techniques for lesser tuberosity osteotomy have been described: in line with the subscapularis tendon or perpendicular to the tendon. Both techniques show a high union rate and good clinical results but currently no biomechanical, radiological (muscular fatty degeneration), or randomized controlled clinical testing has been performed to evaluate significant differences. Subscapularis preserving techniques show good clinical results but are technically very demanding.