Rotator cuff pathology is the main cause of shoulder pain and dysfunction in older adults. When a rotator cuff tear involves the subscapularis tendon, the symptoms are usually more severe and the prognosis after surgery must be guarded. Isolated subscapularis tears represent 18% of all rotator cuff tears and arthroscopic repair is a good alternative primary treatment. However, when the tendon is deemed irreparable, tendon transfers are the only option for younger or high-functioning patients. The aim of this review is to describe the indications, biomechanical principles, and outcomes which have been reported for tendon transfers, which are available for the treatment of irreparable subscapularis tears. The best tendon to be transferred remains controversial. Pectoralis major transfer was described more than 30 years ago to treat patients with failed surgery for instability of the shoulder. It has subsequently been used extensively to manage irreparable subscapularis tendon tears in many clinical settings. Although pectoralis major reproduces the position and orientation of the subscapularis in the coronal plane, its position in the axial plane - anterior to the rib cage - is clearly different and does not allow it to function as an ideal transfer. Consistent relief of pain and moderate recovery of strength and function have been reported following the use of this transfer. In an attempt to improve on these results, latissimus dorsi tendon transfer was proposed as an alternative and the technique has evolved from an open to an arthroscopic procedure. Satisfactory relief of pain and improvements in functional shoulder scores have recently been reported following its use. Both pectoralis minor and upper trapezius transfers have also been used in these patients, but the outcomes that have been reported do not support their widespread use.

中文翻译：

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肌腱转移用于治疗不可修复的肩胛下肌撕裂。


肩袖病理是老年人肩部疼痛和功能障碍的主要原因。当肩袖撕裂累及肩胛下肌腱时，症状通常更严重，术后预后必须谨慎。孤立性肩胛下肌撕裂占所有肩袖撕裂的 18%，关节镜修复是一种很好的替代主要治疗方法。然而，当肌腱被认为无法修复时，肌腱移植是年轻或高功能患者的唯一选择。本综述的目的是描述肌腱移植的适应症、生物力学原理和结果，可用于治疗不可修复的肩胛下肌撕裂。移植的最佳肌腱仍存在争议。 30多年前，胸大肌转移术被描述用于治疗因肩部不稳定而手术失败的患者。随后，它在许多临床环境中被广泛用于治疗不可修复的肩胛下肌腱撕裂。尽管胸大肌再现了肩胛下肌在冠状面中的位置和方向，但其在轴向平面（胸腔前面）的位置明显不同，并且不允许其发挥理想的转移作用。据报道，使用这种转移后，疼痛持续缓解，力量和功能得到适度恢复。为了改善这些结果，提出了背阔肌腱转移作为替代方案，并且该技术已从开放式手术发展为关节镜手术。最近有报道称，使用该产品后，疼痛得到令人满意的缓解，肩部功能评分得到改善。 胸小肌和上斜方肌移植也已用于这些患者，但已报道的结果并不支持其广泛使用。