Objective: Pain-free movement and stability of the shoulder joint after restoration of muscular balance between the internal and external rotators. Eradication of anterior impingement.
Indications: Irreparable rupture of the subscapularis tendon in active patients.
Contraindications: Less active patients who are older than about 60 years. Concomitant infraspinatus tendon rupture. Frozen shoulder. Rotator cuff arthropathy.
Surgical technique: General anesthetic and beach-chair position with the arm freely mobile. Deltopectoral approach. Exposure of the lesser tubercle and the conjoined tendon of coracobrachialis and the short head of the biceps. Half to two thirds of the insertion of pectoralis major at the humeral shaft are detached proximally, held in a suture loop, and passed under the conjoined tendon. The tendon is then fixed transosseously to the lesser tubercle, and range of motion is evaluated. External rotation of up to 30 degrees without tension must be confirmed.
Postoperative management: A shoulder strap is worn for 6 weeks and passive physiotherapy is commenced on day 2 postoperatively. External rotation can only be practiced after week 7.
Results: 23 patients were available to follow-up. There were 13 cases of anterosuperior defect with irreparable supraspinatus tendon. The preoperative Constant Score of 35 points improved to a postoperative score of 68 points. It was not possible to restore powerful internal rotation. Preoperative impingement syndrome was eradicated.