Pectoralis Major Tendon Transfer for Subscapularis Insufficiency: An Operative Technique

Abstract

Background: Pectoralis major tendon (PMT) transfer is an effective surgical treatment for addressing subscapularis insufficiency in younger, active patients. Indications: The primary indication for a PMT transfer is subscapularis insufficiency or irreparable tear in an active, young patient that is not a candidate for reverse shoulder arthroplasty. In addition, patients should have an intact posterosuperior rotator cuff. In this case, the patient is a 41-year-old male with chronic anterior shoulder instability after failed open Bankart stabilization with subscapularis incompetency. Technique Description: The patient was placed in the beach-chair position and a standard deltopectoral approach was utilized. The conjoint tendon and adjacent musculocutaneous nerve were identified and retracted. Subsequently, the sternal head of the PMT was isolated from the clavicular head at the humeral insertion. It was then released, mobilized and passed inferior to the conjoined tendon for reapproximation at the lesser tuberosity with a suture anchor. Results: A previous systematic review demonstrated that patients with isolated subscapularis insufficiency who undergo PMT transfer have significant increase in Constant Score, range of motion, and internal rotation strength. Additionally, a retrospective case series evaluating 22 patients at a 10-year follow-up revealed maintained improvements in Constant Score, Simple Shoulder test, and Visual Analog scale for Pain. However, they found that strength on internal rotation and range of motion significantly regressed to baseline, preoperative levels. Discussion/Conclusion: PMT transfer for subscapularis insufficiency is a viable treatment option for symptomatic subscapularis tendon tears not amenable to repair. It allows for excellent long-term improvements in strength, range of motion and patient reported outcomes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.