Pectoralis major tendon transfer in reverse total shoulder arthroplasty with irreparable subscapularis: surgical technique and preliminary clinical and radiological results

Addressing irreparable subscapularis in conjunction with reverse total shoulder arthroplasty (RTSA) presents challenges. RTSA without subscapularis repair leads to similar clinical results compared to those with a subscapularis repair but with less range of motion in internal rotation (IR). Optimiza...

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Bibliographic Details
Published in:JSES international 2024-05, Vol.8 (3), p.500-507
Main Authors: Valenti, Philippe, Moussa, Mohamad K., Kazum, Efi, Eichinger, Josef K., Murillo Nieto, Carlos, Caruso, Giovanni
Format: Article
Language:English
Subjects:
Pectoralis major
Reverse total shoulder arthroplasty
Shoulder
Shoulder Replacement
Subscapularis repair
Subscapularis tear
Tendon transfer
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Summary:Addressing irreparable subscapularis in conjunction with reverse total shoulder arthroplasty (RTSA) presents challenges. RTSA without subscapularis repair leads to similar clinical results compared to those with a subscapularis repair but with less range of motion in internal rotation (IR). Optimization of IR and anterior stability after RTSA, in the setting of an irreparable subscapularis may be achieved with a pectoralis major (PM) tendon transfer. This study aims to describe a novel surgical technique involving PM transfer in RTSA for irreparable subscapularis and report the initial clinical and radiological outcomes. This study included 13 patients with an average of 65.5 years (range, 52-82 years). All patients underwent a lateralized RTSA with concurrent PM transfer, associated to an irreparable subscapularis, performed by a single surgeon (PV). Preoperative and postoperative range of motion, including internal rotation 1, internal rotation 2, external rotation 1 (ER1) and forward elevation, were measured. The absolute Constant score, the age and sex-adjusted Constant Murley score, Visual Analog Scale and subjective shoulder value were evaluated by the same surgeon. Standard X-rays, preoperative magnetic resonance imaging, and computed tomography scan were performed for all patients. With an average follow-up of 37 months, the mean Constant score improved from 17.7 preoperatively to 61 postoperative (P 
ISSN:2666-6383
2666-6383
DOI:10.1016/j.jseint.2023.12.009