OPERATIVE TREATMENT OF IRREPARABLE RUPTURE OF THE SUBSCAPULARIS

Between 1980 and 1994, 221 shoulders with recurrent anterior glenohume ral subluxation or dislocation were reconstructed at oar institution, At the time of the operation, thirteen shoulders were found to have an irreparable injury of the subscapularis muscle, which we believed to be a contributing factor to the ongoing instability. All but three of the thirteen patients had had two to six precious reconstructions. Ope rative treatment of the irreparable rupture included a dynamic muscle transfer using the pectoralis major in seven shoulders, the pectoralis minor in five, and both of these muscles in one. According to a modif ication of tile grading system of Neer and Foster, the result was sati sfactory for ten shoulders and unsatisfactorg for three at a mean of f ive years after the operation, All shoulders with a satisfactory resul t demonstrated active contraction of the transferred pectoralis muscle and diminished anterior glenohumeral translation, On the basis of our analysis, we concluded that transfer of the pectoralis muscle is effe ctive for reconstruction of the shoulder in patients who have loss of the subscapularis muscle.