Lesser tuberosity osteotomy (LTO) and subscapularis peel (Peel) are two common techniques used to mobilize the subscapularis tendon during anatomic shoulder arthroplasty (TSA). The literature is inconclusive over which technique is optimal, thus controversy exists over which technique should be performed. The purpose of this study was to compare specific functional internal rotation tasks and general outcome scores in TSA patients who received either a LTO or Peel.

A retrospective review of 563 patients treated with primary TSA using either a LTO (n = 358) or Peel (n = 205) with a minimum 2-year follow-up was performed. Subjective internal rotation, active internal rotation, and specific questions related to functional internal rotation isolated from the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) functional questionnaires were reviewed. Other outcomes scores including Visual Analog Scale (VAS) pain and function, Single Assessment Numerical Evaluation (SANE), SST, ASES, and revision rates were compared between the two groups.

The study found no difference in postoperative functional internal rotation and range of motion between LTO and Peel. Patients who received a Peel were shown to have a slightly greater improvement in the ability to perform toileting and a higher average change in SST score which did not reach clinical significance. There was no difference in the percentage of maximal improvement, revision rate or need for revision between the two groups.

No difference was found between the lesser tuberosity osteotomy and subscapularis peel techniques in regards to functional tasks of internal rotation at short-term follow-up.

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