The Lesser Tuberosity Osteotomy Exposure for Total Shoulder Arthroplasty

The lesser tuberosity osteotomy (LTO) is a commonly employed technique for mobilizing the subscapularis tendon during anatomic total shoulder arthroplasty that is performed through a deltopectoral approach. During this procedure, the lesser tuberosity is osteotomized from the proximal aspect of the humerus while maintaining the strong tendon-to-bone attachment of the subscapularis tendon insertion. After the shoulder arthroplasty is performed, the lesser tuberosity osseous fragment is then resecured to the proximal aspect of the humerus with heavy nonabsorbable suture, which allows for direct bone-to-bone compression and healing of the fragment to the proximal aspect of the humerus. This technique may be utilized for subscapularis tendon mobilization in any primary and some revision anatomic total shoulder arthroplasty procedures.