Abstract
Purpose of the study: The purpose of this work was to report the clinical outcomes observed after great pectoral transfer (clavicular head in 8 cases and sterna head in 7) behind the coracoids for irreparable subscapular tears.
Material and method: This was a retrospective analysis of 15 patients, mean age 57 years, with retracted subscapular tears with fatty degeneration grade 3 or greater, associated with a supspinatus tear for 12 cases. The Constant score was not pre and postoperatively. The lift-off test was positive in all patients. The clavicular head (n=8) and the sterna head (n=7) were positioned under the coracoids and fixed with anchors in the trochin using the double row technique. Biceps tenodesis was associated in 12 cases. Immobilisation was maintained for six weeks in neutral rotation with passive mobilization immediately postop and active rehabilitation after the sixth week.
Results: At mean 24 months follow-up (range 12–50), nine patients were very satisfied, three were satisfied, and three were disappointed; one patient had revision with a reverse prosthesis due to anteroposterior instability; one patient developed an infection after a haematoma and retained an elevation deficit and a painful shoulder. The gain was 11 points (2.66 to 13.6 ([p< 0.001]) for pain and 4.5 points (3.2 to 7.7 [p< 0.001]) for force. The gain was non significant for active elevation (7 points) and external rotation (6 points). The lift-off test was negative in 11 of the 15 shoulders. There was no significant difference between the two pectoral heads. This series is limited by the small number of shoulders.
Discussion: Greater pectoral transfer for unreparable tears of the subscapularis improves force and reduces pain. However, compared with data in the literature, outcome is not different if the entire muscle is used or if only the sterna or clavicular heads are used, whether inserted anteriorly or posteriorly on the coracoids.
Correspondence should be addressed to Ghislaine Patte at sofcot@sofcot.fr
