Reinhold Ortmaier1, Fabian Plachel2, Stefan Lederer3, Wolfgang Hitzl4, Alexander Auffarth5, Nicholas Matis6, Herbert Resch7. 1. Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria. Electronic address: r.ortmaier@gmail.com. 2. Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria. Electronic address: fabian.plachel@gmail.com. 3. Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria. Electronic address: s.lederer@salk.at. 4. Department of Biostatistics, Paracelsus Medical University, Strubergasse 21, A-5020 Salzburg, Austria. Electronic address: wolfgang.hitzl@pmu.ac.at. 5. Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria. Electronic address: a.auffarth@salk.at. 6. Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria. Electronic address: n.matis@salk.at. 7. Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria. Electronic address: h.resch@salk.at.
Abstract
BACKGROUND: Treatment strategies after failed pectoralis major tendon transfer (PMTT) are scarce in literature and no information is available for patients treated with reverse shoulder arthroplasty (RSA) for failed PMTT. METHODS: We performed a retrospective outcome study of all patients who underwent revision with RSA after failed PMTT at our institution. From 1999 to 2009 we included 8 patients (8 shoulders). The minimum follow-up was 5 years with a mean follow-up time of 97 months (range, 64-134). Clinical and radiological evaluation comprised range of motion, Constant Murley score (CMS), Simple Shoulder Test (SST) as well as standard X-rays in 2 planes. Pain was measured using VAS pain scale. The patients were asked to rate their satisfaction at final follow-up. RESULTS: All outcome measures improved significantly post-surgical compared to pre-surgical, including the CMS (17.8-62.8), SST (1.8-7.3) and VAS (7.1-1). Active abduction and anterior flexion improved significantly (p < .001) from 65.6° to 125° and from 62.5° to 136.3°, respectively. There were 2 complications. One patient sustained transient musculocutaneous nerve palsy that resolved completely after 5 months and one patient sustained postoperative hematoma and had to be revised 4 days after surgery. 4 (50%) patients rated their results as excellent and 4 (50%) rated them as good. CONCLUSIONS: RSA is a good option for treating patients after failed pectoralis major tendon transfer. After a minimum follow-up of 5 years, functional outcome is good and patient satisfaction is high. LEVEL OF EVIDENCE: Level IV, Case series, Treatment study.
BACKGROUND: Treatment strategies after failed pectoralis major tendon transfer (PMTT) are scarce in literature and no information is available for patients treated with reverse shoulder arthroplasty (RSA) for failed PMTT. METHODS: We performed a retrospective outcome study of all patients who underwent revision with RSA after failed PMTT at our institution. From 1999 to 2009 we included 8 patients (8 shoulders). The minimum follow-up was 5 years with a mean follow-up time of 97 months (range, 64-134). Clinical and radiological evaluation comprised range of motion, Constant Murley score (CMS), Simple Shoulder Test (SST) as well as standard X-rays in 2 planes. Pain was measured using VAS pain scale. The patients were asked to rate their satisfaction at final follow-up. RESULTS: All outcome measures improved significantly post-surgical compared to pre-surgical, including the CMS (17.8-62.8), SST (1.8-7.3) and VAS (7.1-1). Active abduction and anterior flexion improved significantly (p < .001) from 65.6° to 125° and from 62.5° to 136.3°, respectively. There were 2 complications. One patient sustained transient musculocutaneous nerve palsy that resolved completely after 5 months and one patient sustained postoperative hematoma and had to be revised 4 days after surgery. 4 (50%) patients rated their results as excellent and 4 (50%) rated them as good. CONCLUSIONS:RSA is a good option for treating patients after failed pectoralis major tendon transfer. After a minimum follow-up of 5 years, functional outcome is good and patient satisfaction is high. LEVEL OF EVIDENCE: Level IV, Case series, Treatment study.