The Role of Tendon Transfers for Irreparable Rotator Cuff Tears

Abstract

While the latissimus dorsi tendon transfer has historically been performed for posterosuperior RCTs, the lower trapezius transfer is a more anatomic option and has demonstrated promising results in recent studies. Similarly, the pectoralis major transfer has historically been the tendon transfer of choice for anterosuperior RCTs. However, the latissimus dorsi tendon transfer has recently been shown to be a safe and anatomic tendon transfer for subscapularis insufficiency. The treatment of irreparable RCTs involves complex decision making. Tendon transfer procedures can restore the glenohumeral joint force couples, allowing restoration of near-normal shoulder kinematics. Benefits include reliable pain relief, increased function, and increased strength. Proper selection of donor tendon is crucial, and the principles of tendon transfer procedures must be adhered to for maximal benefit.

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

“…In the setting of an irreparable cuff tear and no osteoarthritis in younger patients, tendon transfers may improve shoulder function 6,50,94 . For posterosuperior tears, transfer of the latissimus dorsi 97 is the most common procedure.…”

“…Careful patient selection is required and patients with pseudoparalysis and insufficient subscapularis function probably have much less gain from this procedure 6,94,214 . The variability of results, and the fact that the transferred latissimus tendon provides a quite vertical pull, have led to the development of the lower trapezius transfer 72 , in which the transferred lower trapezius, and the allograft that is required, provide a line of pull that is nearly identical to that of infraspinatus 50 . Results in selected patients have shown significant improvements in pain, function and range of motion 73 , but comparative studies and medium-term results are lacking.…”

“…Results in selected patients have shown significant improvements in pain, function and range of motion 73 , but comparative studies and medium-term results are lacking. In irreparable anterior-superior cuff tears, both pectoralis major and latissimus dorsi have been used, with the latter having a better line of pull, but published series are few so far 50 .…”

Enhancement of External Rotation after Latissimus Dorsi Tendon Transfer (LDTT): A Cadaveric Study

“…The latissimus dorsi is a vast muscle that attaches to the distal portion of the medial bicipital groove between the pectoralis major and subscapularis tendons. Its normal function includes internal rotation, adduction, and backward extension of the humerus [ 11 , 12 ]. In LDTT, the latissimus dorsi tendon is harvested from its medial humeral insertion and reattached to the supraspinatus footprint.…”

“…In LDTT, the latissimus dorsi tendon is harvested from its medial humeral insertion and reattached to the supraspinatus footprint. This allows the latissimus dorsi to restore external shoulder rotation and prevent the superior migration of the humeral head, thus improving deltoid function [ 3 , 5 , 7 , 12 , 13 ].…”