title: Pectoralis major tendon transfer for irreparable subscapularis tears.
abstract: BACKGROUND
  Subscapularis insufficiency is a debilitating condition with few treatment options. Historically, pectoralis major tendon transfer has been suggested when the subscapularis tendon or muscle is deemed irreparable; however, the results of this salvage procedure have been mixed.
  
  
  METHODS
  A comprehensive review of the peer-reviewed literature addressing pectoralis major tendon transfers was performed. The clinical presentation, relevant anatomy, biomechanical rationale, surgical indications, technical considerations, reported outcomes, and significant complications are reviewed in this report. Where possible, attempts at direct comparison of outcomes among surgical techniques and surgical indications have been made.
  
  
  CONCLUSIONS
  Despite the heterogeneous reporting of clinical results, it is clear that surgical indications affect outcomes. Specifically, isolated subscapularis insufficiency shows the best prognosis with pectoralis major tendon transfer. Patients with anterosuperior instability after large rotator cuff tears or shoulder arthroplasty have the least predictable pain relief and worse functional outcomes.
  
  
  METHODS
  Review article.
authors.affiliation: Rothman Institute of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA. Electronic address: gnnelson@gmail.com.
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Nelson
authors.affiliation: Rothman Institute of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Surena
authors.initials: S
authors.lastname: Namdari
authors.affiliation: Department of Orthopedics, Washington University School of Medicine in St Louis, St Louis, MO, USA.
authors.forename: Leesa
authors.initials: L
authors.lastname: Galatz
authors.affiliation: Department of Orthopedics, Washington University School of Medicine in St Louis, St Louis, MO, USA.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Keener
mesh_terms: D006801:Humans; D007593:Joint Instability / Q000601:surgery; D010369:Pectoralis Muscles / Q000601:surgery*; D017006:Rotator Cuff / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D013708:Tendon Injuries / Q000175:diagnosis / Q000601:surgery*; D013709:Tendon Transfer
keywords: Subscapularis; irreparable rotator cuff tear; pectoralis major; tendon transfer