The Impact of Lesser Tuberosity Osteotomy Repair After Reverse Total Shoulder Arthroplasty: A Randomized Controlled Trial
In brief
Lesser tuberosity repair lifts ASES scores by eight points after reverse shoulder arthroplasty
In a patient-blinded randomized trial of 85 shoulders, fixing the lesser tuberosity fragment during reverse total shoulder arthroplasty gave an average ASES score of 90.4 versus 82.3 without repair at two years, and increased the chance of better internal-rotation range about sevenfold. The improvement did not compromise motion in other planes, but longer-term effects remain unknown.
- Journal
- The Journal of bone and joint surgery. American volume (Q1)
- Published
- 4 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Alexander W Aleem, Benjamin M Zmistowski, Julianne Sefko, Ling Chen, Jay D Keener
- PMID
- 42550892
- DOI
- 10.2106/JBJS.25.01330
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (top studies of the week, 9 August 2026).
- Picked for Orthopedics and Sports Medicine (paper of the day, 5 August 2026): The Impact of Lesser Tuberosity Osteotomy Repair After Reverse Total
- Picked for Surgery (paper of the day, 5 August 2026): Therapeutic Level I RCT of LTO repair in rTSA
Abstract
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. The aim of this study was to prospectively compare outcomes following rTSA with and without lesser tuberosity repair for subscapularis management. METHODS: This patient-blinded randomized controlled trial, conducted at a single institution, enrolled patients with a sufficiently intact subscapularis suitable for reattachment. Patients were randomized to either repair or no repair of the lesser tuberosity osteotomy (LTO) fragment to which the subscapularis was attached. Pre- and postoperative assessments involved radiographs, clinical examinations, and patient-reported outcomes, including a validated internal rotation functional score. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. 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 LTO repair. At 2 years of follow-up, the repair group demonstrated significantly better ASES scores compared with the no-repair group (90.4 versus 82.3, p = 0.01). Repair provided 7 times better odds of achieving improved internal rotation range of motion. There were no significant differences in other active shoulder motions or outcome scores. CONCLUSIONS: In primary rTSA, subscapularis reattachment (by repair of the LTO) yielded better functional outcomes and internal rotation range of motion, as well as a trend toward a better internal rotation functional score. 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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.