This is a retrospective long-term study of pectoralis major tendon transfer for irreparable anterosuperior (subscapularis-dominant) rotator cuff tears without advanced arthropathy. It asks whether the promising short-term results of this joint-preserving procedure hold up at 10 years. Twenty-two of 27 patients were re-examined clinically, radiographically, and with ultrasound.
When you face an irreparable subscapularis-dominant cuff tear in a patient under 70 without advanced arthropathy, pectoralis major transfer buys durable pain relief and internal rotation for a decade. Set expectations correctly: counsel the patient that strength will not be restored to normal. The value is pain relief, internal rotation, and joint preservation that defers reverse arthroplasty.
A key decision rule from this data: radiographic arthropathy progression alone is not a reason to revise. Arthropathy grade did not correlate with symptoms, and satisfaction stayed high even as imaging worsened. Remember the contraindications, since they define who is NOT a candidate: infraspinatus tear >50%, Hamada grade >2, and anterior head migration with eccentric glenoid wear.
Technically, the subcoracoid route improves the vector but threatens the musculocutaneous nerve. Transfer only the sternocostal and abdominal portions, strictly deep to the conjoined tendon and anterior to the nerve.
This is a retrospective long-term study of pectoralis major tendon transfer for irreparable anterosuperior (subscapularis-dominant) rotator cuff tears without advanced arthropathy. It asks whether the promising short-term results of this joint-preserving procedure hold up at 10 years. Twenty-two of 27 patients were re-examined clinically, radiographically, and with ultrasound.
When you face an irreparable subscapularis-dominant cuff tear in a patient under 70 without advanced arthropathy, pectoralis major transfer buys durable pain relief and internal rotation for a decade. Set expectations correctly: counsel the patient that strength will not be restored to normal. The value is pain relief, internal rotation, and joint preservation that defers reverse arthroplasty.
A key decision rule from this data: radiographic arthropathy progression alone is not a reason to revise. Arthropathy grade did not correlate with symptoms, and satisfaction stayed high even as imaging worsened. Remember the contraindications, since they define who is NOT a candidate: infraspinatus tear >50%, Hamada grade >2, and anterior head migration with eccentric glenoid wear.
Technically, the subcoracoid route improves the vector but threatens the musculocutaneous nerve. Transfer only the sternocostal and abdominal portions, strictly deep to the conjoined tendon and anterior to the nerve.