title: Magnetic resonance imaging-controlled results of the pectoralis major tendon transfer for irreparable anterosuperior rotator cuff tears performed with standard and modified fixation techniques.
abstract: OBJECTIVE
  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, typically associated with insufficient in-growth of the transferred tissue. We hypothesized that tendon harvest with chips of cancellous bone would improve the tendon-bone interface.
  
  
  METHODS
  Of 62 consecutive pectoralis tendon transfers, 54 shoulders were followed-up at an average of 35 months. In all shoulders, the transferred tendon was rerouted behind the conjoint tendon and fixed by transosseous sutures. In 29 shoulders, the tendon was harvested with a cuff of cancellous bone. In 25 shoulders, the conventional technique with sharp detachment of the tendon was used. Apart from detailed clinical examination of all shoulders, a magnetic resonance image (MRI) was available in 52 shoulders.
  
  
  RESULTS
  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 with 62.2 for the conventional fixations. The MRI showed intact tendons and muscles in 80.8% of shoulders. In 7 shoulders (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.
  
  
  CONCLUSIONS
  A secure method of fixation that avoids secondary ruptures despite insufficiency of the transferred tendon is of great importance. Also the rerouting of the transferred tendon under the conjoined tendon is essential to imitate the natural force vector and the function of an intact subscapularis tendon. Patients in this investigation were also monitored by MRI to verify the integrity of the transferred tendon.
  
  
  CONCLUSIONS
  As a salvage procedure, the pectoralis major tendon transfer provides good results in most cases. Sufficient in-growth of the transferred tissue is essential for the success of the procedure. This seems to be facilitated by both methods.
authors.affiliation: Department of Traumatology and Sports Injuries, University Hospital of Salzburg, Salzburg, Austria. S.Lederer@salk.at
authors.forename: Stefan
authors.initials: S
authors.lastname: Lederer
authors.forename: Alexander
authors.initials: A
authors.lastname: Auffarth
authors.forename: Robert
authors.initials: R
authors.lastname: Bogner
authors.forename: Mark
authors.initials: M
authors.lastname: Tauber
authors.forename: Michael
authors.initials: M
authors.lastname: Mayer
authors.forename: Stefanie
authors.initials: S
authors.lastname: Karpik
authors.forename: Nicholas
authors.initials: N
authors.lastname: Matis
authors.forename: Herbert
authors.initials: H
authors.lastname: Resch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000473:pathology* / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012421:Rupture; D012785:Shoulder Joint / Q000473:pathology / Q000601:surgery; D013537:Sutures; D013709:Tendon Transfer / Q000379:methods*