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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 8, 1059-1065.
doi: 10.1302/0301-620X.90B8.20659  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Transfer of pectoralis major for the treatment of irreparable tears of subscapularis

DOES IT WORK?

B. Elhassan, MD, Assistant Professor of Orthopaedics1; M. Ozbaydar, MD, Research Fellow2; D. Massimini, PhD, Research Assistant3; D. Diller, BA, Research Assistant4; L. Higgins, MD, Orthopaedic Surgeon, Chief of Sports Medicine Shoulder Service5; and J. J. P. Warner, MD, Professor of Orthopedics, Chief the Harvard Shoulder Service4

1 Mayo Clinic, 200 First Street, SW, Rochester, Minnesota 55905, USA.
2 Department of Orthopaedics and Traumatology, Okmeydani Teaching Hospital, Istanbul, Turkey.
3 Massachusetts Institute of Technology
4 Harvard Medical School Department of Orthopaedic Surgery, Division of Shoulder Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA.
5 Harvard Medical School Brigham and Woman Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA.

Correspondence should be sent to Dr B. Elhassan; e-mail: belhassan{at}partners.org

Transfer of pectoralis major has evolved as the most favoured option for the management of the difficult problem of irreparable tears of subscapularis. We describe our experience with this technique in 30 patients divided into three groups. Group I comprised 11 patients with a failed procedure for instability of the shoulder, group II included eight with a failed shoulder replacement and group III, 11 with a massive tear of the rotator cuff. All underwent transfer of the sternal head of pectoralis major to restore the function of subscapularis.

At the latest follow-up pain had improved in seven of the 11 patients in groups I and III, but in only one of eight in group II. The subjective shoulder score improved in seven patients in group I, in one in group II and in six in group III. The mean Constant score improved from 40.9 points (28 to 50) in group I, 32.9 (17 to 47) in group II and 28.7 (20 to 42) in group III pre-operatively to 60.8 (28 to 89), 41.9 (24 to 73) and 52.3 (24 to 78), respectively.

Failure of the tendon transfer was highest in group II and was associated with pre-operative anterior subluxation of the humeral head. We conclude that in patients with irreparable rupture of subscapularis after shoulder replacement there is a high risk of failure of transfer of p?ctoralis major, particularly if there is pre-operative anterior subluxation of the humeral head.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General