Clinical outcome of combined reverse total shoulder arthroplasty combined with pectoralis major transfer for rotator cuff arthropathy: a preliminary study.

purposeReverse total shoulder arthroplasty (RTSA) is promising treatment option for rotator cuff tear arthropathy (CTA), but internal rotation (IR) deficits can arise in patients with irreparable subscapularis tears. The present study reports (1) the early clinical outcomes of RTSA combined with pectoralis major (PM) transfer in patients with CTA and irreparable subscapularis tears and (2) compares these outcomes with those of RTSA without subscapularis repair, with a focus on addressing IR deficiencies and enhancing overall shoulder function.

methodsFrom November 2022 to May 2023, patients who underwent RTSA with PM transfer were reviewed. For comparison, patients who underwent RTSA without subscapularis repair between November 2019 and June 2022 were also included. The inclusion criteria consisted of CTA with severe subscapularis tears, classified as Lafosse grade ≥ 4, and poor subscapularis muscle quality, defined by Goutallier fatty infiltration grade  ≥ 3. Clinical outcomes were assessed using the VAS, Constant, ASES, UCLA, and SANE, range of motion (ROM) and strength. Radiologic evaluations including radiography and MRI were performed. Patients with less than one year of follow-up or lost to final clinical assessment were excluded.

resultsAfter excluding one patient, 22 patients who underwent RTSA with PM transfer were included (mean age: 73.8 ± 6.0 years; follow-up: 16.7 ± 2.1 months). In the comparison group, 55 patients underwent RTSA without subscapularis repair (mean age: 73.6 ± 6.3 years; follow-up: 17.9 ± 3.2 months). For both groups, significant improvements were seen in VAS, Constant, ASES, UCLA, and SANE scores (P < .001), as well as ROM in forward elevation, abduction, and internal rotation at the back. Both groups showed comparable preoperative characteristics and similar postoperative improvements in clinical scores and ROM. However, the PM transfer group demonstrated more frequent reversal of subscapularis-specific tests and significantly greater strength in forward elevation, abduction, and IR at the side.

conclusionRTSA with PM transfer can significantly alleviate pain and improve shoulder function in patients with CTA and irreparable subscapularis tears. Compared to the group without subscapularis repair, the RTSA with PM transfer group demonstrated more frequent reversal of subscapularis-specific tests and significantly greater strength in forward elevation, abduction, and IR at the side. LEVEL OF EVIDENCE: IV; retrospective; case series.