INTRODUCTION:
Several techniques have been described for mobilizing the subscapularis tendon in anatomic total shoulder arthroplasty (TSA). The purpose of this study was to compare subscapularis tendon healing rates, as determined by ultrasound, in patients following anatomic TSA with either a subscapularis tenotomy or subscapularis peel.

METHODS:
This study was a secondary analysis of patients from a previous randomized controlled trial in which patients underwent anatomic TSA and were randomized to either a tenotomy or peel approach. The primary outcome was postoperative tendon healing rates determined on ultrasound at greater than 12 months post-surgery. Secondary outcomes included postoperative tendon thickness measured on ultrasound; elbow position (neutral alignment in the belly-press position versus posterior); internal rotation function measured with the 3rd and 4th questions of the American Shoulder and Elbow Surgeons (ASES) score, and the Western Ontario Osteoarthritis of the Shoulder (WOOS) index. Radiographs were analyzed in patients with torn tendons.

RESULTS:
One hundred patients were randomized to a tenotomy (n=47) or a peel (n=53) approach. Postoperative ultrasound results were available in 88 patients. Tendon healing rates were 95% for tenotomy compared to 75% for peel (p=0.011). Mean postoperative tendon thickness was 4 (SD 1.0) mm and 4 (SD 1) mm for tenotomy and peel groups, respectively (p=.37). Internal rotation function was not associated with healing status (p=.77 and p=.22 for ASES Q3 and Q4 respectively), nor was elbow position (p=0.2) in the belly-press position.

DISCUSSION:
We observed that subscapularis tenotomy had a higher healing rate than peel as determined by ultrasound in TSA. There was no statistically significant difference in postoperative tendon thickness in intact tendons as measured on ultrasound when comparing subscapularis mobilization techniques, nor was there any association between healing status and internal rotation function or elbow position.





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