International Orthopaedics

, Volume 34, Issue 5, pp 689–694 | Cite as

Pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears

  • Iosif Gavriilidis
  • Jörn KircherEmail author
  • Petra Magosch
  • Sven Lichtenberg
  • Peter Habermeyer
Original Paper


The purpose of this study was to evaluate the outcome of subcoracoid pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears. This type of tear involves complete rupture of the subscapularis in combination with either the supraspinatus alone or the supraspinatus and infraspinatus. These ruptures are characterised by a poor quality of the rotator cuff that does not allow for a direct tendon-to-bone reconstruction. Between 2000 and 2006, 15 patients were treated using a deltopectoral approach and transfer of the clavicular part of the pectoralis major to the lesser tuberosity and to the anterior part of the greater tuberosity. After an average follow-up (follow-up rate 100%) of 37 months the average functional rating using the Constant and Murley score (CS) increased from 51.73 ± 16.18 to 68.17 ± 8.84 points (p = 0.005). The mean subcategories of the Constant score for pain (p = 0.005), activities of daily living (p = 0.008) but not for range of motion (p = 0.9), significantly improved. At follow-up 13 patients (87%) were available for magnetic resonance imaging (MRI) of the shoulder. Nine patients (70%) had an intact transferred pectoralis major muscle, two (15%) had one that was thin but intact and two patients a rupture (one complete). Two patients had postoperative haematoma and one patient developed cuff tear arthropathy. The good results confirm that pectoralis major transfer is a reliable treatment option for irreparable anterosuperior rotator cuff injuries with significant improvement in pain and function.


Rotator Cuff Constant Score Great Tuberosity Supraspinatus Tendon Pectoralis Major Muscle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Burkhart SS (1992) Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears. A suspension bridge model. Clin Orthop Relat Res 284:144–152PubMedGoogle Scholar
  2. 2.
    Cofield RH (1985) Rotator cuff disease of the shoulder. J Bone Joint Surg Am 67:974–979PubMedGoogle Scholar
  3. 3.
    Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM (2001) Surgical repair of chronic rotator cuff tears. A prospective long-term study. J Bone Joint Surg Am 83-A:71–77PubMedGoogle Scholar
  4. 4.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMedGoogle Scholar
  5. 5.
    Elhassan B, Ozbaydar M, Massimini D, Diller D, Higgins L, Warner JJ (2008) Transfer of pectoralis major for the treatment of irreparable tears of subscapularis: does it work? J Bone Joint Surg Br 90:1059–1065CrossRefPubMedGoogle Scholar
  6. 6.
    Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8:599–605CrossRefPubMedGoogle Scholar
  7. 7.
    Galatz LM, Connor PM, Calfee RP, Hsu JC, Yamaguchi K (2003) Pectoralis major transfer for anterior-superior subluxation in massive rotator cuff insufficiency. J Shoulder Elbow Surg 12:1–5CrossRefPubMedGoogle Scholar
  8. 8.
    Gerber C, Hersche O, Farron A (1996) Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am 78:1015–1023PubMedGoogle Scholar
  9. 9.
    Gerber C, Krushell RJ (1991) Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br 73:389–394PubMedGoogle Scholar
  10. 10.
    Gerber C, Schneeberger AG, Beck M, Schlegel U (1994) Mechanical strength of repairs of the rotator cuff. J Bone Joint Surg Br 76:371–380PubMedGoogle Scholar
  11. 11.
    Gerber C, Schneeberger AG, Perren SM, Nyffeler RW (1999) Experimental rotator cuff repair. A preliminary study. J Bone Joint Surg Am 81:1281–1290PubMedGoogle Scholar
  12. 12.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83PubMedGoogle Scholar
  13. 13.
    Gumina S, Di Giorgio G, Perugia D, Postacchini F (2008) Deltoid detachment consequent to open surgical repair of massive rotator cuff tears. Int Orthop 32:81–84CrossRefPubMedGoogle Scholar
  14. 14.
    Hamada K, Fukuda H, Mikasa M, Kobayashi Y (1990) Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res 254:92–96PubMedGoogle Scholar
  15. 15.
    Harryman DT 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA 3 rd (1991) Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 73:982–989PubMedGoogle Scholar
  16. 16.
    Hawkins RJ, Misamore GW, Hobeika PE (1985) Surgery for full-thickness rotator-cuff tears. J Bone Joint Surg Am 67:1349–1355PubMedGoogle Scholar
  17. 17.
    Ito J, Morioka T (2003) Surgical treatment for large and massive tears of the rotator cuff. Int Orthop 27:228–231CrossRefPubMedGoogle Scholar
  18. 18.
    Jennings GJ, Keereweer S, Buijze GA, De Beer J, DuToit D (2007) Transfer of segmentally split pectoralis major for the treatment of irreparable rupture of the subscapularis tendon. J Shoulder Elbow Surg 16:837–842CrossRefPubMedGoogle Scholar
  19. 19.
    Jost B, Puskas GJ, Lustenberger A, Gerber C (2003) Outcome of pectoralis major transfer for the treatment of irreparable subscapularis tears. J Bone Joint Surg Am 85-A:1944–1951PubMedGoogle Scholar
  20. 20.
    Klepps SJ, Goldfarb C, Flatow E, Galatz LM, Yamaguchi K (2001) Anatomic evaluation of the subcoracoid pectoralis major transfer in human cadavers. J Shoulder Elbow Surg 10:453–459CrossRefPubMedGoogle Scholar
  21. 21.
    Konrad GG, Sudkamp NP, Kreuz PC, Jolly JT, McMahon PJ, Debski RE (2007) Pectoralis major tendon transfers above or underneath the conjoint tendon in subscapularis-deficient shoulders. An in vitro biomechanical analysis. J Bone Joint Surg Am 89:2477–2484CrossRefPubMedGoogle Scholar
  22. 22.
    McMahon PJ, Debski RE, Thompson WO, Warner JJ, Fu FH, Woo SL (1995) Shoulder muscle forces and tendon excursions during glenohumeral abduction in the scapular plane. J Shoulder Elbow Surg 4:199–208CrossRefPubMedGoogle Scholar
  23. 23.
    Nove-Josserand L, Gerber C, Walch G (1997) Lesions of the anterosuperior rotator cuff. In: Warner JP, Iannotti JP, Gerber C (eds) Complex and revision problems in shoulder surgery. Lippincott-Raven, Philadelphia, pp 165–176Google Scholar
  24. 24.
    Resch H, Povacz P, Ritter E, Matschi W (2000) Transfer of the pectoralis major muscle for the treatment of irreparable rupture of the subscapularis tendon. J Bone Joint Surg Am 82:372–382PubMedGoogle Scholar
  25. 25.
    Ticker JB, Warner JJ (1997) Single-tendon tears of the rotator cuff. Evaluation and treatment of subscapularis tears and principles of treatment for supraspinatus tears. Orthop Clin North Am 28:99–116CrossRefPubMedGoogle Scholar
  26. 26.
    Vandenbussche E, Bensaida M, Mutschler C, Dart T, Augereau B (2004) Massive tears of the rotator cuff treated with a deltoid flap. Int Orthop 28:226–230CrossRefPubMedGoogle Scholar
  27. 27.
    Warner JJ (2001) Management of massive irreparable rotator cuff tears: the role of tendon transfer. Instr Course Lect 50:63–71PubMedGoogle Scholar
  28. 28.
    Warner JJP, Gerber C (1997) Massive tears of the postero-superior rotator cuff. In: Warner JI, Iannoti JP, Gerber C (eds) Complex and revision problems in shoulder surgery. Lippincott-Raven, Philadelphia, pp 161–203Google Scholar
  29. 29.
    Warner JJP, Gerber C (1998) Treatment of massive rotator cuff tears: posterior-superior and anterior-superior. In: Iannotti J (ed) The rotator cuff: current concepts and complex problems. American Academy of Orthopaedic Surgeons, Rosement, pp 59–94Google Scholar
  30. 30.
    Wirth MA, Rockwood CA Jr (1997) Operative treatment of irreparable rupture of the subscapularis. J Bone Joint Surg Am 79:722–731PubMedGoogle Scholar
  31. 31.
    Zafra M, Carpintero P, Carrasco C (2009) Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. Int Orthop 33:457–462CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Iosif Gavriilidis
    • 1
  • Jörn Kircher
    • 2
    Email author
  • Petra Magosch
    • 1
  • Sven Lichtenberg
    • 1
  • Peter Habermeyer
    • 1
  1. 1.Department of Shoulder and Elbow SurgeryATOS ClinicHeidelbergGermany
  2. 2.Department of Orthopaedic SurgeryUniversity Hospital DüsseldorfDüsseldorfGermany

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