Journal article
Pectoralis Major Transfer Over versus Under the Conjoint Tendon for the Treatment of Irreparable Subscapularis Rupture. A Systematic Review Comparing Clinical Outcomes, Complications, and Failure Rates
JSES reviews, reports, and techniques, Vol.6(1), 100600
02/2026
DOI: 10.1016/j.xrrt.2025.100600
Abstract
Introduction
Transfer of the pectoralis major muscle tendon unit has proven to be an effective solution for reconstituting the force couple after rotator cuff tears involving an irreparable subscapularis tendon. The tendon can be routed over or under the conjoint tendon; however, it is unclear if tendon routing influences postoperative outcomes. The purpose of this study was to compare the complication rates and clinical outcome measures between pectoralis major transfer performed with a subcoracoid versus supracoracoid tendon routing.
Methods
We performed a systematic review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, querying MEDLINE (PubMed) and EMBASE databases for studies reporting outcomes and complications following pectoralis major transfer with a minimum of 1-year follow-up. We assessed the methodological quality of each study using the MINORS score and extracted patient demographic, surgical, and outcome data.
Results
Seven studies involving 179 shoulders (174 patients) were included. The mean patient age was 57.6 years with a follow-up of 71.5 months. Tendon routing over (n=76 shoulders) or under (n=103 shoulders) the conjoint tendon showed similar improvements in Constant Score (+20.4 vs. +28.6, P= 0.08). Graft failure rates were also comparable when the pectoralis major tendon was routed over versus under the conjoint tendon (14% vs. 9%, p=0.46). However, graft failure varied by tendon type, with the sternal head having significantly higher failure rate (27%) compared to transfers using the clavicular head (7%) and entire tendon (5%) (p=0.02). Complication rates, additional ipsilateral shoulder surgery, and rates of patient satisfaction were similar with respect to tendon placement above or below the conjoint tendon and graft type.
Conclusion
The complication rate, incidence of subsequent surgery, and Constant-Murley score did not differ based on whether the pectoralis major tendon was placed over or under the conjoint tendon during transfers. However, graft failure rates were greater in cohorts using only the sternocostal head of the pectoralis major tendon, while all other outcomes were similar.
Details
- Title: Subtitle
- Pectoralis Major Transfer Over versus Under the Conjoint Tendon for the Treatment of Irreparable Subscapularis Rupture. A Systematic Review Comparing Clinical Outcomes, Complications, and Failure Rates
- Creators
- Ross ClarkeLema AbuoqabBrian S. TaoPaul SherbanMohammad AbdelaalKevin A. HaoJoseph W. GalvinJeffrey BortmanBrian R. WatermanJosef K. EichingerXinning Li
- Resource Type
- Journal article
- Publication Details
- JSES reviews, reports, and techniques, Vol.6(1), 100600
- DOI
- 10.1016/j.xrrt.2025.100600
- ISSN
- 2666-6391
- eISSN
- 2666-6391
- Publisher
- Elsevier
- Language
- English
- Electronic publication date
- 10/24/2025
- Date published
- 02/2026
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9985019149102771
Metrics
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