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Pectoralis major transfer may yield improvements for irreparable subscapularis tears
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CHICAGO — Results presented at the American Shoulder and Elbow Surgeons Annual Meeting showed significant subjective and objective improvements at 20-year follow-up among patients with irreparable subscapularis tears treated with a pectoralis major transfer.
“Overall function and pain remain excellent at 20 years,” Christian Gerber, MD, said in his presentation here. “I think that this was surprising but testifying to the fact that rotator cuff salvage operations may also have value.”
At 20-year follow-up, Gerber and colleagues clinically and radiographically assessed 24 patients who underwent pectoralis major transfer.
“We had 10 isolated tears, six reparable supraspinatus and repaired supraspinatus tears and eight irreparable tears, which had previously been believed to lead to inferior results,” Gerber said.
Results showed an increase in absolute Constant score from 44 to 66, as well as an increase in the relative Constant score between 5-year and 20-year follow-up. Gerber noted patients had a subjective shoulder value of 71% of a normal shoulder and an anterior elevation of about 137°.
“Abduction was 132°, and patients did lose external rotation over time,” Gerber said. “They also lost internal rotation between the 5-year and 20-year period and were close to the internal rotation before surgery.”
However, he noted patients had a low pain score at 20 years. Patients with isolated tears had no significant clinical differences to patients with reparable supraspinatus tears, according to Gerber, as well as no significant differences among patients with combined reparable supraspinatus tears plus subscapularis.
“Cuff tear arthropathy did not progress in a relevant fashion except for the two cases where the pectoralis transfer had pulled off,” Gerber said. “Whether this is coincidental or not is difficult to say, but overall the progression was not relevant.” – by Casey Tingle
Reference:
Ernstbrunner L, et al. Paper 25. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 12-14, 2018; Chicago.
Disclosure: Gerber reports no relevant financial disclosures.