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

Published:October 16, 2019DOI:https://doi.org/10.1016/j.arthro.2019.05.046

      Purpose

      To compare the biomechanical effectiveness of human dermal allograft (HDA) anterior capsular reconstruction (ACR) and pectoralis major tendon transfer (PMTT) for treating irreparable subscapularis tears with capsular insufficiency in human cadaver shoulders.

      Methods

      Glenohumeral rotational range of motion and translation were measured in 6 cadaveric shoulders under the following 5 conditions: intact, deficient subscapularis/anterior capsule, ACR using HDA, HDA ACR with concomitant PMTT, and PMTT alone.

      Results

      The deficient subscapularis/anterior capsule condition significantly increased external and total rotational range of motion at 0° (P < .001, P < .001) and 30° (P = .005, P = .002) abduction as well as anterior-inferior translation (P ≤ .001 to .03). HDA ACR, both with and without PMTT, restored anterior-inferior stability to that of the intact condition; however, PMTT alone did not restore anterior-inferior translation or rotational range of motion.

      Conclusions

      HDA ACR for treating irreparable subscapularis tears with capsular insufficiency restored anterior-inferior glenohumeral translation and rotational range of motion at time 0 in human cadaver shoulders.

      Clinical Relevance

      Anterior capsule reconstruction may be a viable option for treating massive irreparable subscapularis tears with capsular insufficiency.
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