Irreparable Subscapularis Tears: Current Tendon Transfer Options

Abstract

Purpose of review: Irreparable subscapularis tears, especially in younger patients with higher functional demands, present a challenging entity. Pectoralis major and latissimus dorsi tendon transfers are commonly considered for surgical management of this pathology, yet no consensus exists regarding the superior option. The purpose of this article is to review the most current tendon transfer techniques for irreparable subscapularis tears.

Recent findings: For decades, transfer of the pectoralis major has been considered the gold standard technique for irreparable subscapularis tears. This transfer was found to reduce pain and improve functional outcome scores, yet range of motion and force of internal rotation were not maintained in long-term follow-up studies. The latissimus dorsi tendon transfer for the same indications has demonstrated biomechanical superiority in recent cadaveric studies with promising short-term results clinically. Both pectoralis major and latissimus dorsi tendon transfers improve outcomes of patients with irreparable subscapularis tears. Future comparative studies are still needed to determine superiority amongst techniques.

Keywords: Irreparable subscapularis tendon tears; Latissimus dorsi transfer; Pectoralis major transfer; Tendon transfer.

Fig. 1

X-ray and MRI findings of tendon transfer candidates. A Concentric glenohumeral joint without evidence of static decentering. B Grashey AP of the shoulder, without degenerative glenohumeral findings. C Axial T2-weighted MRI demonstrating a retracted, torn subscapularis

Fig. 2

Open, anterior LD tendon transfer. A Exposure to the bare lesser tuberosity. B Torn subscapularis retrieved and elevated to accommodate tendon transfer. C Pectoralis retracted away from LD tendon. D LD tendon carefully dissected away from teres major. E Traction sutures placed LD tendon. F Gentle digital mobilization achieves adequate excursion to transfer LD tendon to lesser tuberosity. G Triple-loaded all tape suture placed at inferior aspect of lesser tuberosity. H Traction suture through LD tendon tied into native supraspinatus anterior cable. I Triple-loaded all tape sutures passed through 5.5-mm SwiveLock anchor, placed superior to lesser tuberosity, providing broad footprint reduction. J Remnant subscapularis sutured over the LD tendon, providing additional biologic support