This Article Full Text Full Text (PDF) CME: Take the activity for this article: CME 4: October, November, December 2003 [Supplementary Material] Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jost, B. Articles by Gerber, C. Search for Related Content PubMed PubMed Citation Articles by Jost, B. Articles by Gerber, C. Social Bookmarking             What's this?

Outcome of Pectoralis Major Transfer for the Treatment of Irreparable Subscapularis Tears

Investigation performed at the Department of Orthopaedics, University of Zurich, Balgrist, Zurich, Switzerland

Bernhard Jost, MD
Gabor J. Puskas, MD
Christian Gerber, MD
Department of Orthopaedics, University of Zurich, Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland. E-mail address for C. Gerber: christian.gerber{at}balgrist.ch

Alois Lustenberger, MD
Blumenrain 91, 2503 Biel/Bienne, Switzerland

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Chronic tears of the subscapularis tendon with or without associated tears of the supraspinatus and infraspinatus tendons may lead to pain and dysfunction of the shoulder. If conservative treatment fails and repair of the musculotendinous unit is impossible, transfer of the pectoralis major tendon can be attempted to substitute for lost subscapularis function.

Methods: Twenty-eight patients underwent a total of thirty consecutive pectoralis major transfers at an average age of fifty-three years. There were twelve isolated subscapularis tears and eighteen subscapularis tears associated with a tear of the supraspinatus or the supraspinatus and infraspinatus. All patients were examined clinically and with standard radiographs.

Results: The mean relative Constant score increased from 47% preoperatively to 70% at an average of thirty-two months postoperatively (p < 0.0001). The mean Constant scores for pain (p = 0.0009) and activities of daily living (p < 0.0001), the range of forward flexion (p < 0.05), and abduction strength (p = 0.001) also improved. Thirteen patients (14 shoulders) were very satisfied, ten patients (eleven shoulders) were satisfied, two patients (two shoulders) were disappointed, and three patients (three shoulders) were dissatisfied with the result. The average subjective shoulder value increased from 23% preoperatively to 55% postoperatively (p = 0.0009). In patients with a massive tear, the outcome was less favorable when the torn supraspinatus tendon was irreparable, as determined preoperatively or intraoperatively, than when it was reparable (average relative Constant scores, 49% and 79%, respectively; p = 0.002).

Conclusions: Pectoralis major transfer results in improvement for patients with an irreparable subscapularis tear with or without an associated reparable supraspinatus tear. If an irreparable subscapularis tear is associated with an irreparable supraspinatus tear, the results are less favorable, and pectoralis major transfer may not be warranted.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				S. Namdari, R. F. Henn III, and A. Green Traumatic Anterosuperior Rotator Cuff Tears: The Outcome of Open Surgical Repair J. Bone Joint Surg. Am., September 1, 2008; 90(9): 1906 - 1913. [Abstract] [Full Text] [PDF]

				B. D. Owens, B. J. Nelson, and D. C. Taylor Acute Brachial Plexus Compression After Pectoralis Major Transfer for Subscapularis Insufficiency Am. J. Sports Med., January 1, 2008; 36(1): 173 - 175. [Full Text] [PDF]

				G. G. Konrad, N. P. Sudkamp, P. C. Kreuz, J. T. Jolly, P. J. McMahon, and R. E. Debski Pectoralis Major Tendon Transfers Above or Underneath the Conjoint Tendon in Subscapularis-Deficient Shoulders. An in Vitro Biomechanical Analysis J. Bone Joint Surg. Am., November 1, 2007; 89(11): 2477 - 2484. [Abstract] [Full Text] [PDF]

				B. Jost, M. Zumstein, C. W.A. Pfirrmann, and C. Gerber Long-Term Outcome After Structural Failure of Rotator Cuff Repairs J. Bone Joint Surg. Am., March 1, 2006; 88(3): 472 - 479. [Abstract] [Full Text] [PDF]

				B. Fuchs, M. K. Gilbart, J. Hodler, and C. Gerber Clinical and Structural Results of Open Repair of an Isolated One-Tendon Tear of the Rotator Cuff J. Bone Joint Surg. Am., February 1, 2006; 88(2): 309 - 316. [Abstract] [Full Text] [PDF]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2003 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.