Subscapularis-sparing Deltopectoral Approach to the Shoulder

Abstract

The deltopectoral approach is a popular exposure for shoulder surgery. It requires release of the subscapularis and anterior capsule to gain access to the glenohumeral joint. Subscapularis dysfunction, rupture, and shoulder instability have been reported after the traditional deltopectoral approach. We describe a novel surgical approach to prevent this complication by detaching only the inferior 30% to 50% of the subscapularis during humeral head resurfacing and present the preliminary results. Twenty shoulders in 20 patients were treated with humeral head resurfacing using the subscapularis-sparing technique. The surgical approach used an L-shaped flap of the lower subscapularis. The superior 50% to 70% of the insertion was left intact. The humeral head was delivered through the capsulotomy inferior to the remaining intact subscapularis tendon. After the resurfacing, the subscapularis capsule flap was repaired anatomically using a suture anchor technique. Patients were evaluated at mean follow-up of 18 months. Average active shoulder flexion improved by 56 degrees, abduction improved by 56 degrees, and external rotation improved by 54 degrees. The mean shoulder scores improved as follows: University of California at Los Angeles 19 to 25, American Shoulder and Elbow Surgeons 34 to 65, Bankart 57 to 82, and Constant 37 to 69 (P<0.05). The elbow forward belly push and lift-off tests were negative at 4 weeks postoperatively and at the last follow-up visit. Eighteen of the 20 shoulders had good-to-excellent results. With the morbidity caused by failure or dysfunction of the subscapularis after the deltopectoral approach, we believe that the subscapularis-sparing technique minimizes the trauma and risk of failure to the repair and may provide several potential advantages.