H. Resch et al., Transfer of the pectoralis major muscle for the treatment of irreparable rupture of the subscapularis tendon, J BONE-AM V, 82A(3), 2000, pp. 372-382
Citations number
19
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine","da verificare
Background The clinical diagnosis of a tear of the subscapularis tendon is
difficult, and the resulting delays frequently cause a major time-lapse bef
ore repair is attempted. Diagnostic delay often means that surgical repair
is no longer possible. In twelve patients who had an irreparable tear of th
e subscapularis tendon, the superior one-half to two-thirds of the tendon o
f the pectoralis major muscle was used as a substitute for the subscapulari
s tendon. In order to adapt the orientation of the transferred muscle to th
at of the subscapularis, it was routed behind the conjoined tendon of the c
oracobrachialis muscle and the short head of the biceps to the lesser tuber
osity,
Methods: The operations were performed between May 1993 and June 1997, The
average age of the twelve patients was sixty-five years old (range, forty-n
ine to eighty-one years old). Eight patients had an isolated rupture of the
subscapularis tendon, and four had a concomitant lesion in the form of eit
her a partial or a complete rupture of the supraspinatus tendon. The domina
nt symptoms were anterior shoulder pain and weakness that had responded poo
rly to nonoperative therapy. Four patients also had signs of recurrent ante
rior instability.
Results: After an average follow-up interval of twenty-eight months (range,
twenty-four to fifty-four months), nine of the twelve patients assessed th
e final result as excellent or good; three, as fair; and none, as poor. Pai
n was reduced, with the score improving from an average of 1.7 points (of a
maximum of 15 points) preoperatively to an average of 9.6 points postopera
tively, The patients' subjective functional evaluation improved from an ave
rage score of 20 points preoperatively to an average of 63 points postopera
tively, The average functional rating with use of the Constant and Murley s
core increased from 26.9 to 67.1 percent of normal. All four preoperatively
unstable shoulders were stable at the time of the latest follow-up.
Conclusions: This repair technique can be recommended as a reconstructive p
rocedure for elderly patients who have an irreparable tear of the subscapul
aris tendon.