Peter Lapner1, J Whitcomb Pollock2, Tinghua Zhang3, Sara Ruggiero4, Franco Momoli5, Adnan Sheikh6, George S Athwal7. 1. Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. Electronic address: plapner@toh.ca. 2. Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. 3. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 4. Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada. 5. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada. 6. Department of Medical Imaging, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. 7. Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada; University of Western Ontario, London, ON, Canada.
Abstract
BACKGROUND: Controversy exists regarding the optimal technique of subscapularis tendon mobilization during anatomic shoulder arthroplasty. The purpose of this prospective, randomized, double-blind study was to compare internal rotation strength in the belly-press position and functional outcomes between the subscapularis tenotomy and subscapularis peel approaches during shoulder arthroplasty. METHODS:Patients undergoing anatomic shoulder arthroplasty were randomized to either a tenotomy or peel approach. The primary outcome was internal rotation strength in the belly-press position, measured by an electronic handheld dynamometer at 24 months postoperatively. Secondary outcomes included the Western Ontario Osteoarthritis of the Shoulder (WOOS) index score, American Shoulder and Elbow Surgeons (ASES) score, range of motion, radiographic lucencies, and adverse events. RESULTS: We randomized 100 patients to subscapularis tenotomy (n = 47) or peel (n = 53). Eighty-one percent of the cohort returned for 24 months' follow-up. Compared with baseline measures, mean internal rotation strength in the belly-press position and WOOS and ASES scores improved in both groups at final follow-up (P < .0001). Intention-to-treat analysis for internal rotation strength at 24 months revealed no significant difference (P = .57) between tenotomy (mean, 4.9 kg; SD, 3.8 kg) and peel (mean, 5.4 kg; SD, 3.9 kg). Comparison of WOOS and ASES scores demonstrated no significant differences between groups at any time point. The healing rates by ultrasound were 72% for tenotomy and 71% for peel (P = .99). DISCUSSION: No statistically significant difference in internal rotation strength was identified between the tenotomy and peel groups. The secondary outcomes were not significantly different between groups.
RCT Entities:
BACKGROUND: Controversy exists regarding the optimal technique of subscapularis tendon mobilization during anatomic shoulder arthroplasty. The purpose of this prospective, randomized, double-blind study was to compare internal rotation strength in the belly-press position and functional outcomes between the subscapularis tenotomy and subscapularis peel approaches during shoulder arthroplasty. METHODS:Patients undergoing anatomic shoulder arthroplasty were randomized to either a tenotomy or peel approach. The primary outcome was internal rotation strength in the belly-press position, measured by an electronic handheld dynamometer at 24 months postoperatively. Secondary outcomes included the Western Ontario Osteoarthritis of the Shoulder (WOOS) index score, American Shoulder and Elbow Surgeons (ASES) score, range of motion, radiographic lucencies, and adverse events. RESULTS: We randomized 100 patients to subscapularis tenotomy (n = 47) or peel (n = 53). Eighty-one percent of the cohort returned for 24 months' follow-up. Compared with baseline measures, mean internal rotation strength in the belly-press position and WOOS and ASES scores improved in both groups at final follow-up (P < .0001). Intention-to-treat analysis for internal rotation strength at 24 months revealed no significant difference (P = .57) between tenotomy (mean, 4.9 kg; SD, 3.8 kg) and peel (mean, 5.4 kg; SD, 3.9 kg). Comparison of WOOS and ASES scores demonstrated no significant differences between groups at any time point. The healing rates by ultrasound were 72% for tenotomy and 71% for peel (P = .99). DISCUSSION: No statistically significant difference in internal rotation strength was identified between the tenotomy and peel groups. The secondary outcomes were not significantly different between groups.
Authors: Philipp Moroder; Lucca Lacheta; Marvin Minkus; Katrin Karpinski; Frank Uhing; Sheldon De Souza; Michael van der Merwe; Doruk Akgün Journal: J Clin Med Date: 2022-06-10 Impact factor: 4.964
Authors: Sohil S Desai; Ryan A Nelson; Kayla C Korbel; William N Levine; Steven S Goldberg Journal: J Orthop Surg Res Date: 2022-01-11 Impact factor: 2.359
Authors: Benjamin Kerzner; Mariano E Menendez; Nabil Mehta; Morgan L Angotti; Matthew R Cohn; Gerald R Williams; Grant E Garrigues Journal: Arthrosc Tech Date: 2022-07-14