Skip to main content

Advertisement

SpringerLink
Log in

Irreparable Subscapularis Tears: Current Tendon Transfer Options

  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

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.

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Huegel J, Williams AA, Soslowsky LJ. Rotator cuff biology and biomechanics: a review of normal and pathological conditions. Curr Rheumatol Rep. 2015;17(1):476. https://doi.org/10.1007/s11926-014-0476-x.

    Article  PubMed  Google Scholar 

  2. Abboud JA, Soslowsky LJ. Interplay of the static and dynamic restraints in glenohumeral instability. Clin Orthop Relat Res. 2002;400:48–57. https://doi.org/10.1097/00003086-200207000-00007.

    Article  Google Scholar 

  3. Oh JH, Jun BJ, McGarry MH, Lee TQ. Does a critical rotator cuff tear stage exist?: a biomechanical study of rotator cuff tear progression in human cadaver shoulders. J Bone Joint Surg Am. 2011;93(22):2100–9. https://doi.org/10.2106/jbjs.J.00032.

    Article  PubMed  Google Scholar 

  4. Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012;31(4):589–604. https://doi.org/10.1016/j.csm.2012.07.001.

    Article  PubMed  Google Scholar 

  5. Warner JJ. Management of massive irreparable rotator cuff tears: the role of tendon transfer. Instr Course Lect. 2001;50:63–71.

    CAS  PubMed  Google Scholar 

  6. Neri BR, Chan KW, Kwon YW. Management of massive and irreparable rotator cuff tears. J Shoulder Elbow Surg. 2009;18(5):808–18. https://doi.org/10.1016/j.jse.2009.03.013.

    Article  PubMed  Google Scholar 

  7. •• Burnier M, Lafosse T. Pectoralis major and anterior latissimus dorsi transfer for subscapularis tears. Curr Rev Musculoskelet Med. 2020;13(6):725–33. https://doi.org/10.1007/s12178-020-09674-4. Recent review article emphasizing an author preference of latissimus dorsi tendon transfer utilizing a combined open-arthroscopic approach, using an axillary open exposure to harvest and mobilize the latissimus dorsi and arthroscopic techniques for tendon fixation.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Mun SW, Kim JY, Yi SH, Baek CH. Latissimus dorsi transfer for irreparable subscapularis tendon tears. J Shoulder Elbow Surg. 2018;27(6):1057–64. https://doi.org/10.1016/j.jse.2017.11.022.

    Article  PubMed  Google Scholar 

  9. Elhassan BT, Wagner ER, Bishop AT. Feasibility of contralateral trapezius transfer to restore shoulder external rotation: part I. J Shoulder Elbow Surg. 2012;21(10):1363–9. https://doi.org/10.1016/j.jse.2011.10.031.

    Article  PubMed  Google Scholar 

  10. Li X, Cusano A, Eichinger J. Eden-Hybinette and pectoralis major transfer for recurrent shoulder instability due to failed Latarjet and chronic subscapularis rupture. Orthopedics. 2017;40(1):e182–7. https://doi.org/10.3928/01477447-20161006-02.

    Article  PubMed  Google Scholar 

  11. Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br Vol. 1991;73(3):389–94. https://doi.org/10.1302/0301-620x.73b3.1670434.

    Article  CAS  Google Scholar 

  12. Resch H, Povacz P, Ritter E, Matschi W. Transfer of the pectoralis major muscle for the treatment of irreparable rupture of the subscapularis tendon. J Bone Joint Surg Am. 2000;82(3):372–82. https://doi.org/10.2106/00004623-200003000-00008.

    Article  CAS  PubMed  Google Scholar 

  13. Paladini P, Campi F, Merolla G, Pellegrini A, Porcellini G. Pectoralis minor tendon transfer for irreparable anterosuperior cuff tears. J Shoulder Elbow Surg. 2013;22(6):e1-5. https://doi.org/10.1016/j.jse.2012.12.030.

    Article  PubMed  Google Scholar 

  14. Kany J, Guinand R, Croutzet P, Valenti P, Werthel JD, Grimberg J. Arthroscopic-assisted latissimus dorsi transfer for subscapularis deficiency. Eur J Orthop Surg Traumatol. 2016;26(3):329–34. https://doi.org/10.1007/s00590-016-1753-3.

    Article  PubMed  Google Scholar 

  15. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am. 2007;89(6):1184–93. https://doi.org/10.2106/jbjs.F.00007.

    Article  PubMed  Google Scholar 

  16. Keating JF, Waterworth P, Shaw-Dunn J, Crossan J. The relative strengths of the rotator cuff muscles. A cadaver study. J Bone Joint Surg Br Vol. 1993;75(1):137–40. https://doi.org/10.1302/0301-620x.75b1.8421011.

    Article  CAS  Google Scholar 

  17. Morag Y, Jamadar DA, Miller B, Dong Q, Jacobson JA. The subscapularis: anatomy, injury, and imaging. Skeletal Radiol. 2011;40(3):255–69. https://doi.org/10.1007/s00256-009-0845-0.

    Article  PubMed  Google Scholar 

  18. Kadaba MP, Cole A, Wootten ME, McCann P, Reid M, Mulford G, et al. Intramuscular wire electromyography of the subscapularis. J Orthop Res. 1992;10(3):394–7. https://doi.org/10.1002/jor.1100100312.

    Article  CAS  PubMed  Google Scholar 

  19. Kato K. Innervation of the scapular muscles and its morphological significance in man. Anat Anz. 1989;168(2):155–68.

    CAS  PubMed  Google Scholar 

  20. Aluisio FV, Osbahr DC, Speer KP. Analysis of rotator cuff muscles in adult human cadaveric specimens. Am J Orthop (Belle Mead NJ). 2003;32(3):124–9.

    PubMed  Google Scholar 

  21. Symeonides PP. The significance of the subscapularis muscle in the pathogenesis of recurrent anterior dislocation of the shoulder. J Bone Joint Surg Br Vol. 1972;54(3):476–83.

    Article  CAS  Google Scholar 

  22. Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF. Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med. 1997;25(1):13–22. https://doi.org/10.1177/036354659702500104.

    Article  CAS  PubMed  Google Scholar 

  23. MacMahon PJ, Taylor DH, Duke D, Brennan DD, O’Brien J, Eustace SJ. Contribution of full-thickness supraspinatus tendon tears to acquired subcoracoid impingement. Clin Radiol. 2007;62(6):556–63. https://doi.org/10.1016/j.crad.2007.01.004.

    Article  CAS  PubMed  Google Scholar 

  24. Bergin D, Parker L, Zoga A, Morrison W. Abnormalities on MRI of the subscapularis tendon in the presence of a full-thickness supraspinatus tendon tear. AJR Am J Roentgenol. 2006;186(2):454–9. https://doi.org/10.2214/ajr.04.1723.

    Article  PubMed  Google Scholar 

  25. Neviaser RJ, Neviaser TJ. Recurrent instability of the shoulder after age 40. J Shoulder Elbow Surg. 1995;4(6):416–8. https://doi.org/10.1016/s1058-2746(05)80032-1.

    Article  CAS  PubMed  Google Scholar 

  26. Goldberg DB, Tamate TM, Hasegawa M, Kane TJKT, You JS, Crawford SN. Literature review of subscapularis tear, associated injuries, and the available treatment options. Hawai’i J Health Soc Welfare. 2022;81(3 Suppl 1):2–7.

    Google Scholar 

  27. Sugihara T, Nakagawa T, Tsuchiya M, Ishizuki M. Prediction of primary reparability of massive tears of the rotator cuff on preoperative magnetic resonance imaging. J Shoulder Elbow Surg. 2003;12(3):222–5. https://doi.org/10.1016/s1058-2746(02)86888-4.

    Article  PubMed  Google Scholar 

  28. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83.

    Article  Google Scholar 

  29. Nové-Josserand L, Edwards TB, O’Connor DP, Walch G. The acromiohumeral and coracohumeral intervals are abnormal in rotator cuff tears with muscular fatty degeneration. Clin Orthop Relat Res. 2005;433:90–6. https://doi.org/10.1097/01.blo.0000151441.05180.0e.

    Article  Google Scholar 

  30. Komperda KW, Adamson GJ, Itami Y, McGarry MH, Kantor A, Lin CC, et al. Anterior capsule reconstruction versus pectoralis major transfer for irreparable subscapularis tears involving the anterior capsule: a comparative biomechanical cadaveric study. Arthroscopy. 2019;35(11):3002–8. https://doi.org/10.1016/j.arthro.2019.05.046.

    Article  PubMed  Google Scholar 

  31. Edwards TB, Williams MD, Labriola JE, Elkousy HA, Gartsman GM, O’Connor DP. Subscapularis insufficiency and the risk of shoulder dislocation after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2009;18(6):892–6. https://doi.org/10.1016/j.jse.2008.12.013.

    Article  PubMed  Google Scholar 

  32. Chiavaras MM, Jacobson JA, Smith J, Dahm DL. Pectoralis major tears: anatomy, classification, and diagnosis with ultrasound and MR imaging. Skeletal Radiol. 2015;44(2):157–64. https://doi.org/10.1007/s00256-014-1990-7.

    Article  PubMed  Google Scholar 

  33. Konrad GG, Sudkamp NP, Kreuz PC, Jolly JT, McMahon PJ, Debski RE. Pectoralis major tendon transfers above or underneath the conjoint tendon in subscapularis-deficient shoulders. An in vitro biomechanical analysis. J Bone Joint Surg Am Vol. 2007;89(11):2477–84. https://doi.org/10.2106/jbjs.F.00811.

    Article  Google Scholar 

  34. Shin JJ, Saccomanno MF, Cole BJ, Romeo AA, Nicholson GP, Verma NN. Pectoralis major transfer for treatment of irreparable subscapularis tear: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1951–60. https://doi.org/10.1007/s00167-014-3229-5.

    Article  PubMed  Google Scholar 

  35. •• Ernstbrunner L, Wieser K, Catanzaro S, Agten CA, Fornaciari P, Bauer DE, et al. Long-term outcomes of pectoralis major transfer for the treatment of irreparable subscapularis tears: results after a mean follow-up of 20 years. J Bone Joint Surg Am. 2019;101(23):2091–100. https://doi.org/10.2106/jbjs.19.00172. Demonstrated good to excellent clinical outcomes at long-term follow-up at nearly 20 years, following pectoralis major tendon transfer for isolated and combined subscapularis tears.

    Article  PubMed  Google Scholar 

  36. Jennings GJ, Keereweer S, Buijze GA, De Beer J, DuToit D. Transfer of segmentally split pectoralis major for the treatment of irreparable rupture of the subscapularis tendon. J Shoulder Elbow Surg. 2007;16(6):837–42. https://doi.org/10.1016/j.jse.2007.03.030.

    Article  PubMed  Google Scholar 

  37. Burley HEK, Haładaj R, Olewnik Ł, Georgiev GP, Iwanaga J, Tubbs RS. The clinical anatomy of variations of the pectoralis minor. Surg Radiol Anat: SRA. 2021;43(5):645–51. https://doi.org/10.1007/s00276-021-02703-y.

    Article  PubMed  Google Scholar 

  38. Servasier L, Jeudy J, Raimbeau G, Bigorre N. Arthroscopic release of the pectoralis minor tendon as an adjunct to acromioplasty in the treatment of subacromial syndrome associated with scapular dyskinesia. Orthop Traumatol Surg Res: OTSR. 2022;108(2): 103211. https://doi.org/10.1016/j.otsr.2022.103211.

    Article  PubMed  Google Scholar 

  39. Yamakado K. Arthroscopic-assisted pectoralis minor transfer for irreparable anterosuperior massive rotator cuff tear. Arthrosc Tech. 2018;7(3):e193–8. https://doi.org/10.1016/j.eats.2017.08.070.

    Article  PubMed  PubMed Central  Google Scholar 

  40. •• Sánchez Carbonel JF, Hinz M, Lozano C, Kleim BD, Imhoff AB, Siebenlist S. Pectoralis major and pectoralis minor transfer for irreparable subscapularis tendon tears. Oper Orthop Traumatol. 2022;34(1):45–54. https://doi.org/10.1007/s00064-021-00760-5. Recent study, finding pectoralis major and minor transfer to improve strength and range of motion in young active patients with long-term follow-up.

    Article  PubMed  Google Scholar 

  41. Lee KT, Mun GH. A systematic review of functional donor-site morbidity after latissimus dorsi muscle transfer. Plast Reconstr Surg. 2014;134(2):303–14. https://doi.org/10.1097/prs.0000000000000365.

    Article  CAS  PubMed  Google Scholar 

  42. Koh CE, Morrison WA. Functional impairment after latissimus dorsi flap. ANZ J Surg. 2009;79(1–2):42–7. https://doi.org/10.1111/j.1445-2197.2008.04797.x.

    Article  PubMed  Google Scholar 

  43. •• Elhassan BT, Wagner ER, Kany J. Latissimus dorsi transfer for irreparable subscapularis tear. J Shoulder Elbow Surg. 2020;29(10):2128–34. https://doi.org/10.1016/j.jse.2020.02.019. Reported outcomes following latissimus dorsi tendon transfer (LDT) for subscapularis insufficiency, demonstrating potential in LDT to yield significant clinical improvements when long-term follow-up can be assessed.

    Article  PubMed  Google Scholar 

  44. Elhassan B, Ozbaydar M, Massimini D, Diller D, Higgins L, Warner JJ. Transfer of pectoralis major for the treatment of irreparable tears of subscapularis: does it work? J Bone Joint Surg Br Vol. 2008;90(8):1059–65. https://doi.org/10.1302/0301-620x.90b8.20659.

    Article  CAS  Google Scholar 

  45. •• Kontaxis A, Lawton CD, Sinatro A, Bachner E, Lamplot JD, Dines DM, et al. Biomechanical analysis of latissimus dorsi, pectoralis major, and pectoralis minor transfers in subscapularis-deficient shoulders. J Shoulder Elbow Surg. 2022;31(2):420–7. https://doi.org/10.1016/j.jse.2021.08.022. Biomechanical analysis demonstrating latissimus dorsi tendon transfer most closely approximates native subscapularis mechanics, regarding maintaining an internal rotation moment arm with slight reductions in adductive moment arm.

    Article  PubMed  Google Scholar 

  46. •• Luo Z, Lin J, Sun Y, Zhu K, Wang C, Chen J. Outcome comparison of latissimus dorsi transfer and pectoralis major transfer for irreparable subscapularis tendon tear: a systematic review. Am J Sports Med. 2022;50(7):2032–41. https://doi.org/10.1177/03635465211018216. Systematic review finding latissimus dorsi tendon transfer to demonstrate better clinical outcomes post-operatively than pectoralis major tendon transfer for isolated subscapularis tears, though more high-quality randomized controlled trials are needed.

    Article  PubMed  Google Scholar 

  47. • Gates S, Sager B, Collett G, Chhabra A, Khazzam M. Surgically relevant anatomy of the axillary and radial nerves in relation to the latissimus dorsi tendon in variable shoulder positions: a cadaveric study. Should Elb. 2020;12(1):24–30. https://doi.org/10.1177/1758573218825476. Understanding proximity of neurovascular structures and dynamic nature in various shoulder positions during latissimus dorsi tendon transfer decreases iatrogenic radial nerve injury.

    Article  Google Scholar 

  48. Elhassan BT. Feasibility of latissimus and teres major transfer to reconstruct irreparable subscapularis tendon tear: an anatomic study. J Shoulder Elbow Surg. 2015;24(4):e102–3. https://doi.org/10.1016/j.jse.2014.12.035.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston SC 29412, Clinical Science Building MSC, Code 708, Charleston, SC, USA

    Jared J. Reid, Richard J. Friedman & Joseph K. Eichinger

  2. Rush University, Chicago, IL, USA

    Grant E. Garrigues

Authors
  1. Jared J. Reid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Grant E. Garrigues
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard J. Friedman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph K. Eichinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jared J. Reid.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of these authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Reid, J.J., Garrigues, G.E., Friedman, R.J. et al. Irreparable Subscapularis Tears: Current Tendon Transfer Options. Curr Rev Musculoskelet Med 17, 68–75 (2024). https://doi.org/10.1007/s12178-023-09881-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-023-09881-9

Keywords

Search

Navigation