Arthroscopically Assisted Pectoralis Minor Transfer for Anterosuperior Massive Rotator Cuff Tear With Irreparable Subscapularis Tears Leads to Significant Improvement in Pain and Function at Short-Term Follow-Up.

Purpose: To report the results of an arthroscopically assisted pectoralis minor transfer with an expanded indication to include Lafosse type 4 cases. In addition, prognostic factors for pectoralis minor transfer, including the Lafosse classification, were explored.

Methods: Outcomes of arthroscopically assisted pectoralis minor tendon transfer for anterosuperior massive rotator cuff tear with irreparable subscapularis tears with a minimum follow-up of 24 months were retrospectively reviewed. Severe pseudoparesis with flexion of less than 30° was not indicated. All patients were evaluated preoperatively and postoperatively using a modified University of California Los Angeles (UCLA) score, active range of motion, and the visual analog pain scale. Multiple regression models were used to determine predictors for UCLA score and elevation.

Results: Seventy-four consecutive patients (mean, 69.4 years; 65 men) were evaluated. The mean UCLA score increased from 15.3 preoperatively to 30.9 postoperatively (P < .001). The mean active elevation increased from 104° preoperatively to 148° postoperatively (P < .001). The mean active external rotation increased from 47° preoperatively to 57° postoperatively (P < .001). The visual analog pain scale improved from 62 to 11 mm postoperatively (P < .001). There were no serious complications, but 1 was revised with reverse shoulder due to ongoing pain. In multiple regression analysis, the positive predictors of UCLA and elevation were the preoperative external rotation angle (P = .0028) and elevation angle (P = .00067), respectively. Lafosse classification was not a significant factor.

Conclusions: Arthroscopically assisted pectoralis minor transfer led to significant improvement in overall shoulder pain and function. Better preoperative range of motion was a significant predictor of better clinical outcomes; Lafosse classification was not significant as a prognostic factor.

Level of evidence: Level IV, retrospective therapeutic case series.