Anterior Capsule Reconstruction Versus Pectoralis Major Transfer for Irreparable Subscapularis Tears Involving the Anterior Capsule: A Comparative Biomechanical Cadaveric Study

Komperda, Kazimierz; Adamson, Gregory J.; Itami, Yasuo; McGarry, Michelle H.; Kantor, Adam; Lin, Charles C.; Lee, Thay Q.

doi:10.1016/j.arthro.2019.05.046

Cited by 14 publications

(15 citation statements)

References 25 publications

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“… 122 A variety of options have been proposed for anterior capsule reconstruction including autografts (tensor fascia lata, hamstrings), tendon allograft, or human dermal allograft. 123 A recent cadaveric study by Komperda et al revealed that anterior capsular reconstruction was superior to pectoralis major tendon transfer to restore anterior and inferior humeral head translation. 123 Further, the addition of an anterior latissimus dorsi tendon transfer to an anterior capsular reconstruction did not enhance antero-inferior humeral head stability.…”

Section: Rotator Cuffmentioning

confidence: 99%

“… 123 A recent cadaveric study by Komperda et al revealed that anterior capsular reconstruction was superior to pectoralis major tendon transfer to restore anterior and inferior humeral head translation. 123 Further, the addition of an anterior latissimus dorsi tendon transfer to an anterior capsular reconstruction did not enhance antero-inferior humeral head stability. 119 …”

Section: Rotator Cuffmentioning

confidence: 99%

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Shoulder biomechanics in normal and selected pathological conditions

et al. 2020

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The stability of the glenohumeral joint depends on soft tissue stabilizers, bone morphology and dynamic stabilizers such as the rotator cuff and long head of the biceps tendon. Shoulder stabilization techniques include anatomic procedures such as repair of the labrum or restoration of bone loss, but also non-anatomic options such as remplissage or tendon transfers. Rotator cuff repair should restore the cuff anatomy, reattach the rotator cable and respect the coracoacromial arch whenever possible. Tendon transfer, superior capsular reconstruction or balloon implantation have been proposed for irreparable lesions. Shoulder rehabilitation should focus on restoring balanced glenohumeral and scapular force couples in order to avoid an upward migration of the humeral head and secondary cuff impingement. The primary goal of cuff repair is to be as anatomic as possible and to create a biomechanically favourable environment for tendon healing. Cite this article: EFORT Open Rev 2020;5:508-518. DOI: 10.1302/2058-5241.5.200006

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Section: Rotator Cuffmentioning

confidence: 99%

Section: Rotator Cuffmentioning

confidence: 99%

Shoulder biomechanics in normal and selected pathological conditions

et al. 2020

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“…5,6 Moreover, ISScT might lead to anterior instability or pseudoparalysis. 9,67 Currently, salvage options for ISScT include anterior capsule reconstruction, 36,62 tendon transfer, 5,34 and reverse shoulder arthroplasty. 10,64 In recent cadaveric studies, anterior capsule reconstruction has been developed for treating ISScT with the theoretical feasibility to restore the anteroinferior shoulder stability but with decreased range of motion (ROM) as a result.…”

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confidence: 99%

“…10,64 In recent cadaveric studies, anterior capsule reconstruction has been developed for treating ISScT with the theoretical feasibility to restore the anteroinferior shoulder stability but with decreased range of motion (ROM) as a result. 36,54,62 Reverse shoulder arthroplasty has been proposed for older patients with shoulder instability and osteoarthritis 17,20 but it is not recommended for active or young patients without severe arthrosis. [10][11][12]34 Tendon transfer has been widely used to treat ISScT given its effects of pain relief, ROM recovery, and shoulder function improvement.…”

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confidence: 99%

Outcome Comparison of Latissimus Dorsi Transfer and Pectoralis Major Transfer for Irreparable Subscapularis Tendon Tear: A Systematic Review

et al. 2021

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Background: Latissimus dorsi transfer (LDT) and pectoralis major transfer (PMT) were developed to treat an irreparable subscapularis tendon tear (ISScT); however, the difference in their outcomes remains unclear. Purpose: To systematically review and compare the outcomes of LDT and PMT for ISScT. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed through a comprehensive search of Embase, PubMed, and the Cochrane Library. Studies of LDT or PMT were included according to the inclusion and exclusion criteria. The primary outcome was the Constant-Murley score (CMS) at the final follow-up. Secondary outcomes included the subjective shoulder value (SSV), visual analog scale (VAS) score for pain, active shoulder range of motion, and the belly-press and lift-off tests. Postoperative failure and complication rates were the safety outcome measures. Outcomes were summarized into the LDT and PMT groups, and results were compared statistically ( P < .05). Results: Twelve studies were included in this review: 184 shoulders from 9 studies for the PMT group and 85 shoulders from 3 studies for the LDT group. For the PMT and LDT groups, the mean ages were 58.9 and 55.1 years, respectively, and the mean follow-up was 66.9 and 17.4 months, respectively. Overall, the LDT and PMT groups improved in the primary outcome (CMS) and secondary outcomes (SSV, VAS, ROM, and belly-press and lift-off tests), with low rates of failure and complication. When compared with the PMT group, the LDT group showed more significant improvements in CMS (35.2 vs 24.7; P < .001), active forward flexion (44.3° vs 14.7°; P < .001), abduction (35.0° vs 17.6°; P < .002), and positive belly-press test rate (45% vs 27%; P < .001). No statistically significant difference was seen between the groups in postoperative failure rate, complication rate, mean improvement of active internal rotation, VAS, or SSV. Conclusion: In general, LDT showed significantly better clinical outcomes postoperatively than did PMT. The available fair-quality evidence suggested that LDT might be a better choice for ISScT. Further evaluations on the relative benefits of the 2 surgical approaches are required, with more high-quality randomized controlled studies.

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“…Although this study demonstrated no additional benefit in glenohumeral translation or range of motion when ACR was combined with PMMT, this may actually represent the optimal treatment to restore both shoulder stability and function. In summary, Komperda et al 1 provide biomechanical evidence to existing clinical observations that PMTT alone is unable to restore anterior shoulder stability in the setting of subscapularis and anterior capsular deficiency. At least at time zero, ACR using HDA seems to be a reasonable solution to this difficult problem.…”

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confidence: 80%

Editorial Commentary: Anterior Capsular Reconstruction for Subscapularis Deficiency: The Definitive Treatment or a Helpful Adjunct?

Shin

Woodmass

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Anterior glenohumeral instability in the setting of irreparable subscapularis deficiency represents a difficult clinical scenario for the treating shoulder surgeon. Anterior capsular reconstruction with humeral dermal allograft improved glenohumeral translation stability and range of motion to near-normal values whereas pectoralis major tendon transfer was unable to do so. However, placement of a static spacer does not restore the dynamic force couple or shoulder kinematics. Further research is needed to evaluate the functional outcomes using this reconstruction technique.

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Anterior Capsule Reconstruction Versus Pectoralis Major Transfer for Irreparable Subscapularis Tears Involving the Anterior Capsule: A Comparative Biomechanical Cadaveric Study

Cited by 14 publications

References 25 publications

Shoulder biomechanics in normal and selected pathological conditions

Shoulder biomechanics in normal and selected pathological conditions

Outcome Comparison of Latissimus Dorsi Transfer and Pectoralis Major Transfer for Irreparable Subscapularis Tendon Tear: A Systematic Review

Editorial Commentary: Anterior Capsular Reconstruction for Subscapularis Deficiency: The Definitive Treatment or a Helpful Adjunct?

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