The Impact of Lesser Tuberosity Osteotomy Repair After Reverse Total Shoulder Arthroplasty: A Randomized…

Randomized trialThe Journal of bone and joint surgery. American volume· Aug 2026

The Impact of Lesser Tuberosity Osteotomy Repair After Reverse Total Shoulder Arthroplasty: A Randomized Controlled Trial.

Alexander W Aleem, Benjamin M Zmistowski, Julianne Sefko … Jay D Keener

ArthroplastyRandomized trialTreatmentQ1IF 3.2

Lesser tuberosity osteotomy repair gives better odds of improved internal rotation after shoulder replacement

The Impact of Lesser Tuberosity Osteotomy Repair After Reverse Total Shoulder Arthroplasty: A Randomized Controlled Trial.

Alexander W Aleem … Jay D Keener

The Journal of bone and joint surgery · Aug 2026 · Q1 in Orthopedics

Background

Although reverse total shoulder arthroplasty (rTSA) is widely used to treat a variety of complex shoulder pathologies, the management of the subscapularis tendon during rTSA remains controversial.

Purpose

The aim of this study was to prospectively compare outcomes following rTSA with and without lesser tuberosity repair for subscapularis management.

Methods

Were randomized to either repair or no repair of the lesser tuberosity osteotomy (lesser tuberosity osteotomy) fragment to which the subscapularis was attached.

n = 81 patients

Results

repair gives 7 times better odds of regaining internal rotation

Repair

90.4ASES s

No repair

82.3ASES s

More results

Eighty-five shoulders in 81 patients met the inclusion criteria and had at least 2 years of follow-up.

Forty-three of these shoulders had been randomized to lesser tuberosity osteotomy repair.

More results

At 2 years of follow-up, the repair group demonstrated significantly better American Shoulder and Elbow Surgeons scores compared with the no-repair group (90.4 versus 82.3, p = 0.01).

There were no significant differences in other active shoulder motions or outcome scores.

“

Conclusion · 1 of 2

In primary rTSA, subscapularis reattachment (by repair of the lesser tuberosity osteotomy) yielded better functional outcomes and internal rotation range of motion, as well as a trend toward a better internal rotation functional score.

Conclusion · 2 of 2

These benefits were seen without sacrificing shoulder motion in other planes. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

The Impact of Lesser Tuberosity Osteotomy Repair After Reverse Total Shoulder Arthroplasty: A Randomized Controlled Trial.

The Impact of Lesser Tuberosity Osteotomy Repair After Reverse Total Shoulder Arthroplasty: A Randomized Controlled Trial.

Related papers