BACKGROUND: One recognized salvage option in the treatment of an irreparable subscapularis tear is the pectoralis major tendon transfer (PMT). We aimed to analyze the long-term clinical and imaging outcome of PMT for irreparable subscapularis deficiency. METHODS: Twenty-eight consecutive patients representing 30 shoulders underwent PMT at a mean age of 53.0 years (range, 35 to 67 years). At a mean of 19.7 years (range, 18 to 22 years) postoperatively, 24 shoulders (80%) were clinically examined and 21 were radiographically and sonographically assessed. The long-term results were compared with preoperative findings and previously published short-term results. RESULTS: The mean relative Constant score (percentage of age and sex-matched normal scores; CS%) and the Subjective Shoulder Value (SSV) both improved significantly from preoperatively (CS%, 47%, and SSV, 22%) to postoperatively (CS%, 77%, and SSV, 71%; p < 0.001 for both). All patients rated their results as good or excellent. Active anterior elevation was improved from preoperatively (120°) to postoperatively (131°), but the difference was not significant. Active internal and external rotation decreased significantly from the short-term (32-month) follow-up to the time of the latest follow-up (p = 0.005 and p = 0.002, respectively); however, internal rotation remained at 6 points compared with the 8 points recorded at short-term follow-up and external rotation decreased only from a mean of 51° to 39°. Loss of active range of motion was not observed subjectively and was not subjectively limiting, represented by the high ultimate SSV and overall satisfaction. Four shoulders (19%) showed evidence of glenohumeral arthropathy (Samilson and Prieto grade 3), but clinically were mildly symptomatic to asymptomatic at the time of the latest follow-up (CS% range, 67% to 88%; SSV range, 70% to 80%). Rupture of the PMT was sonographically identified in 2 patients (10%) and was associated with radiographic evidence of advanced cuff tear arthropathy (Hamada stages ≥4). Six (20%) of the initial 30 shoulders were revised, and 1 (4%) of the 24 shoulders that were clinically examined underwent reverse total shoulder arthroplasty. CONCLUSIONS: At long-term follow-up, PMT for isolated and combined subscapularis tears is associated with good to excellent clinical results. Although one-third of the shoulders developed mildly symptomatic or asymptomatic osteoarthritis, the need for salvage with use of reverse total shoulder arthroplasty was rare. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
BACKGROUND: One recognized salvage option in the treatment of an irreparable subscapularis tear is the pectoralis major tendon transfer (PMT). We aimed to analyze the long-term clinical and imaging outcome of PMT for irreparable subscapularis deficiency. METHODS: Twenty-eight consecutive patients representing 30 shoulders underwent PMT at a mean age of 53.0 years (range, 35 to 67 years). At a mean of 19.7 years (range, 18 to 22 years) postoperatively, 24 shoulders (80%) were clinically examined and 21 were radiographically and sonographically assessed. The long-term results were compared with preoperative findings and previously published short-term results. RESULTS: The mean relative Constant score (percentage of age and sex-matched normal scores; CS%) and the Subjective Shoulder Value (SSV) both improved significantly from preoperatively (CS%, 47%, and SSV, 22%) to postoperatively (CS%, 77%, and SSV, 71%; p < 0.001 for both). All patients rated their results as good or excellent. Active anterior elevation was improved from preoperatively (120°) to postoperatively (131°), but the difference was not significant. Active internal and external rotation decreased significantly from the short-term (32-month) follow-up to the time of the latest follow-up (p = 0.005 and p = 0.002, respectively); however, internal rotation remained at 6 points compared with the 8 points recorded at short-term follow-up and external rotation decreased only from a mean of 51° to 39°. Loss of active range of motion was not observed subjectively and was not subjectively limiting, represented by the high ultimate SSV and overall satisfaction. Four shoulders (19%) showed evidence of glenohumeral arthropathy (Samilson and Prieto grade 3), but clinically were mildly symptomatic to asymptomatic at the time of the latest follow-up (CS% range, 67% to 88%; SSV range, 70% to 80%). Rupture of the PMT was sonographically identified in 2 patients (10%) and was associated with radiographic evidence of advanced cuff tear arthropathy (Hamada stages ≥4). Six (20%) of the initial 30 shoulders were revised, and 1 (4%) of the 24 shoulders that were clinically examined underwent reverse total shoulder arthroplasty. CONCLUSIONS: At long-term follow-up, PMT for isolated and combined subscapularis tears is associated with good to excellent clinical results. Although one-third of the shoulders developed mildly symptomatic or asymptomatic osteoarthritis, the need for salvage with use of reverse total shoulder arthroplasty was rare. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Authors: José Fernando Sánchez Carbonel; Maximilian Hinz; Christian Lozano; Benjamin Daniel Kleim; Andreas B Imhoff; Sebastian Siebenlist Journal: Oper Orthop Traumatol Date: 2022-02-03 Impact factor: 1.154
Authors: Lukas Ernstbrunner; Malik Jessen; Marco Rohner; Manuel Dreu; Samy Bouaicha; Karl Wieser; Paul Borbas Journal: BMC Musculoskelet Disord Date: 2021-04-16 Impact factor: 2.362