{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T10:42:22Z","timestamp":1779273742183,"version":"3.51.4"},"reference-count":28,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T00:00:00Z","timestamp":1674172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: This study compared the healing rates of lesser tuberosity osteotomy (LTO) for anatomic total shoulder arthroplasty (TSA), repaired with either standard knot tying or a tensionable construct. Second, we evaluated LTO healing in stemmed and stemless prostheses and identified the patient characteristics associated with healing. Methods: An analysis of consecutive primary TSAs approached with an LTO performed by a single surgeon between 2016 and 2020 was conducted. In the first two years of the study period, the LTOs were repaired with four #2 polyblend sutures passed through drill tunnels and around a short press-fit stem, followed by manual knot tying. Subsequently, a tensionable construct with suture tapes (TCB) was universally adopted. The radiographic appearance of the LTO was evaluated at a minimum of six months postoperatively. Results: A total of 340 patients met the study criteria, including 168 with manual knot tying, 84 TCB repairs with a stemmed implant, and 88 TCB repairs with a stemless implant. There was no difference in the baseline demographics between the groups. The LTO healing rate of the manual knot tying group (85%) was lower than that of the stemmed (95%) and stemless (98%) TCB groups (p &lt; 0.001). When directly comparing the LTO healing between the stemmed and stemless TCB groups, the differences were not significant (p = 0.44). Across all constructs, the body mass index (BMI) was higher in the displaced nonunion group (p = 0.04), with a failure rate of 9.4% for a BMI between 30 and 40, 12.5% for a BMI between 40 and 50, and 28.6% for a BMI &gt; 50. The rate of tobacco use was higher in the displaced nonunion group (p = 0.037). Conclusion: A tensionable construct improves LTO healing compared to manual knot tying, irrespective of the implant type. In addition to the surgical technique, the patient factors that influence tuberosity healing include a greater BMI and tobacco use. Level of evidence: Level III, retrospective comparative study.<\/jats:p>","DOI":"10.3390\/jcm12030834","type":"journal-article","created":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T02:52:21Z","timestamp":1674183141000},"page":"834","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Lesser Tuberosity Osteotomy Healing in Stemmed and Stemless Anatomic Shoulder Arthroplasty Is Higher with a Tensionable Construct and Affected by Body Mass Index and Tobacco Use"],"prefix":"10.3390","volume":"12","author":[{"given":"Cameron","family":"Phillips","sequence":"first","affiliation":[{"name":"Oregon Shoulder Institute, Medford, OR 97504, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignacio","family":"Pasqualini","sequence":"additional","affiliation":[{"name":"Oregon Shoulder Institute, Medford, OR 97504, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo","family":"Barros","sequence":"additional","affiliation":[{"name":"Instituto de Hombro, Av. Rodrigo de Ch\u00e1vez Oe2-115, Quito 170104, Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariano E.","family":"Menendez","sequence":"additional","affiliation":[{"name":"Oregon Shoulder Institute, Medford, OR 97504, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey L.","family":"Horinek","sequence":"additional","affiliation":[{"name":"Oregon Shoulder Institute, Medford, OR 97504, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Ardebol","sequence":"additional","affiliation":[{"name":"Oregon Shoulder Institute, Medford, OR 97504, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2641-5920","authenticated-orcid":false,"given":"Patrick J.","family":"Denard","sequence":"additional","affiliation":[{"name":"Oregon Shoulder Institute, Medford, OR 97504, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.jse.2017.08.003","article-title":"Outcomes for Subscapularis Management Techniques in Shoulder Arthroplasty: A Systematic Review","volume":"27","author":"Choate","year":"2018","journal-title":"J. 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Am."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/834\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:11:27Z","timestamp":1760119887000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/834"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,20]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12030834"],"URL":"https:\/\/doi.org\/10.3390\/jcm12030834","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,20]]}}}