BACKGROUND:
Subscapularis failure is a troublesome complication following anatomic total shoulder arthroplasty (aTSA). Commonly discarded during aTSA, the long head of the biceps tendon (LHBT) may offer an efficient and cheap autograft for the augmentation of the subscapularis repair during aTSA. The purpose of this study was to biomechanically compare a standard subscapularis peel repair to two methods of subscapularis peel repair augmented with LHBT.

METHODS:
18 human cadaveric shoulders (61 ± 9 years of age) were used in this study. Shoulders were randomly assigned to biomechanically compare subscapularis peel repair with (1) traditional single-row repair, (2) single-row with horizontal LHBT augmentation, or (3) single-row with v-shaped LHBT augmentation. Shoulders underwent biomechanical testing on a servohydraulic testing system to compare cyclic displacement, load to failure, and stiffness.

RESULTS:
There were no significant differences in the cyclic displacement between the three techniques in the superior, middle, or inferior portion of the subscapularis repair (p>0.05). The horizontal (436.7 ± 113.3 N; p=0.011) and v-shape (563.3 ± 101.0 N; p< 0.001) repair demonstrated significantly greater load to failure compared to traditional repair (344.4 ± 82.4 N). The v-shape repair was significantly greater load to failure compared to the horizontal repair (p< 0.001). The horizontal (61.6 ± 8.4 N/mm; p< 0.001) and the v-shape (62.8 ± 6.1; p< 0.001) demonstrated significantly greater stiffness compared to the traditional repair (47.6 ± 6.2 N). There was no significant difference in the stiffness of the horizontal and v-shape repairs (p=0.770).

CONCLUSIONS:
Subscapularis peel repair augmentation with LHBT autograft following aTSA confers greater time zero load to failure and stiffness when compared to a standard subscapularis peel repair.





Polls results
1

On a scale of 1 to 10, rate how much this article will change your clinical practice?

NO change
BIG change
66% Article relates to my practice (18/27)
25% Article does not relate to my practice (7/27)
7% Undecided (2/27)
2

Will this article lead to more cost-effective healthcare?

48% Yes (13/27)
33% No (9/27)
18% Undecided (5/27)
3

Was this article biased? (commercial or personal)

7% Yes (2/27)
74% No (20/27)
18% Undecided (5/27)
4

What level of evidence do you think this article is?

0% Level 1 (0/27)
25% Level 2 (7/27)
44% Level 3 (12/27)
25% Level 4 (7/27)
3% Level 5 (1/27)