Pectoralis Major and Anterior Latissimus Dorsi Transfer for Subscapularis Tears
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SURGICAL MANAGEMENT OF MASSIVE IRREPARABLE CUFF TEARS (J SANCHEZ-SOTELO, SECTION EDITOR)
Pectoralis Major and Anterior Latissimus Dorsi Transfer for Subscapularis Tears Marion Burnier 1 & Thibault Lafosse 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Irreparable subscapularis tears represent a challenging entity, especially when they occur in younger patients with high functional demands. Tendon transfers are one of the options considered for surgical management for this pathology. The purpose of this article is to review the surgical technique and outcome of the two most common tendon transfers considered for irreparable subscapularis tears: pectoralis major and latissimus dorsi. Recent Findings Transfer of the pectoralis major has been considered for decades the transfer of choice for irreparable subscapularis tears. Recently, a series with long-term follow-up (over 18 years) supported the reduction in pain and improvement in functional scores and patient satisfaction after pectoralis major transfer. However, the range of motion and the force in internal rotation were not maintained over time. Transfer of the latissimus dorsi to the lesser tuberosity has been recently described as an alternative with a sound biomechanical rationale and encouraging short-term results. Summary Transfer of the pectoralis major and the transfer of latissimus dorsi to the lesser tuberosity are the two transfers most commonly considered for patients with irreparable subscapularis tears. Transfer of the pectoralis major has a much longer track record. Both procedures seem to improve outcomes. Comparative studies are needed to determine the relative indications of these two procedures. Keywords Anterosuperior rotator cuff tear . Irreparable rotator cuff tear . Latissimus dorsi transfer . Massive rotator cuff tear . Pectoralis major transfer . Shoulder tendon transfer . Subscapularis tendon tear
Introduction Rotator cuff pathology remains one of the most common shoulder conditions treated surgically [1]. The rotator cuff Marion Burnier and Thibault Lafosse equally contributed to the redaction of this Manuscript This article is part of the Topical Collection on Surgical Management of Massive Irreparable Cuff Tears. * Marion Burnier [email protected] Thibault Lafosse [email protected] 1
Hand and Upper Extremity Surgical Institute, Clinique du Medipole, 17 avenue Condorcet, Villeurbanne, France
2
Alps Surgery Institute: Hand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Clinique Générale d’Annecy, Annecy, France
muscles include the supraspinatus, the infraspinatus, the teres minor, and the subscapularis muscle. In association with the periscapular muscles, the rotator cuff plays a critical role in the balance of shoulder biomechanics. A primary function of the rotator cuff is to dynamically maintain the center of rotation of the glenohumeral joint and avoid superior subluxation of the humeral head by resisting the upward vector of the deltoid muscle [2, 3]. As
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