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Deutscher Kongress für Orthopädie und Unfallchirurgie, 75. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 97. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 52. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

25. - 28.10.2011, Berlin

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MRI-controlled results of the pectoralis major tendon transfer for irreparable anterosuperior rotator cuff tears

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  • S. Lederer - Universitätsklinik für Unfallchirurgie, Traumatologie, Salzburg, Austria
  • A. Auffarth - Universitätsklinik für Unfallchirurgie, Traumatologie, Salzburg, Austria
  • R. Bogner - Universitätsklinik für Unfallchirurgie, Traumatologie, Salzburg, Austria
  • M. Tauber - ATOS Klinik München, Schulter- und Ellenbogenchirurgie, München, Germany
  • M. Mayer - Universitätsklinik für Unfallchirurgie, Traumatologie, Salzburg, Austria
  • H. Resch - Universitätsklinik für Unfallchirurgie, Traumatologie, Salzburg, Austria

Deutscher Kongress für Orthopädie und Unfallchirurgie. 75. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 97. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 52. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 25.-28.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocPO12-1582

doi: 10.3205/11dkou562, urn:nbn:de:0183-11dkou5627

Published: October 18, 2011

© 2011 Lederer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Questionnaire: Irreparable ruptures of the subscapularis tendon lead to impaired function of the shoulder joint. In such cases, transfer of the pectoralis major tendon has led to encouraging results. The procedure fails periodically. These failures are typically associated with insufficient in-growth of the transferred tissue.

Methods: Of 62 consecutive pectoralis tendon transfers, 54 shoulders were followed up at an average of 35 months. In all cases, the transferred tendon was rerouted behind the conjoint tendon and fixed by transosseous sutures. In 29 cases, the tendon was harvested with a cuff of cancellous bone. In 25 cases the conventional technique with sharp detachment of the tendon was used. The hypothesis tested was that this would improve the tendon-bone interface. Apart from detailed clinical examination of all shoulders, an MRI was available in 52 cases.

Results and Conclusions: The overall Constant score had improved from an average of 38.8 points preoperatively to 63.4 points at follow-up. Shoulders treated with the new fixation technique scored 64.4 compared to 62.2 for the conventional fixations. The MRI showed intact tendons and muscles in 80.8% of cases. In 7 cases (13.5%), the transferred tendon was ruptured. Two of these were treated with the new fixation technique. Mean patient satisfaction score was 8.2 points.

As a salvage procedure, the pectoralis major tendon transfer provides good results in the majority of cases. Sufficient in-growth of the transferred tissue is essential for the success of the procedure. This seems to be facilitated by both methods.