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Pectoralis major transfer for treatment of irreparable subscapularis tear: a systematic review

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Irreparable ruptures of the subscapularis tendon lead to impaired function of the shoulder and presents a surgically complex problem. Transfer of the pectoralis major tendon has been reported as a possible treatment option. The purpose of this systematic review is to critically examine the outcomes of pectoralis major transfers for the treatment of irreparable subscapularis tears.

Methods

A systematic review of the literature was performed using search of electronic databases. No language restrictions were applied. Case reports, review articles, and operative techniques without outcome data were excluded. All the outcomes reported by each study were analyzed and when possible, data were pooled to generate frequency-weighted values to summarize outcomes.

Results

Eight studies with a total 195 shoulders were included in this systematic review. The mean age of patients was 58.8 years (range 18–81 years) and the mean follow-up was 33.4 months (range 6–80 months). Constant scores improved from a mean pre-operative score of 37.8 ± 6.8, to a mean postoperative score of 61.3 ± 6.5 (p < 0.0001). Pain scores could not be pooled as different scales were used. Nevertheless, a trend in pain reduction was noted in all papers. Functional outcomes were less favorable in patients with massive rotator cuff tears or previous shoulder replacements. Moreover, the Constant scores were significantly higher in patients following subcoracoid transfer of the pectoralis major tendon compared to patients who received supracoracoid transfer (p < 0.001). The overall reported incidence of postoperative nerve palsy is low (one transient musculocutaneous nerve palsy and one axillary nerve dysfunction out of 195 cases).

Conclusions

The systematic review based on frequency-weighted means demonstrated improvement in shoulder function, strength and pain relief after pectoralis major transfer for irreparable subscapularis tear.

Level of evidence

IV.

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Conflict of interest

Authors declare that they have no relevant conflict of interest in connection with the submitted article.

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Authors and Affiliations

  1. Department of Orthopaedics, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada

    Jason J. Shin

  2. Department of Orthopaedics, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy

    Maristella F. Saccomanno

  3. Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, IL, USA

    Brian J. Cole, Anthony A. Romeo, Gregory P. Nicholson & Nikhil N. Verma

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  1. Jason J. Shin
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  2. Maristella F. Saccomanno
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  3. Brian J. Cole
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  6. Nikhil N. Verma
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Correspondence to Jason J. Shin.

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Shin, J.J., Saccomanno, M.F., Cole, B.J. et al. Pectoralis major transfer for treatment of irreparable subscapularis tear: a systematic review. Knee Surg Sports Traumatol Arthrosc 24, 1951–1960 (2016). https://doi.org/10.1007/s00167-014-3229-5

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  • DOI: https://doi.org/10.1007/s00167-014-3229-5

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