Clinical outcomes of fully arthroscopic latissimus dorsi and teres major transfer for the treatment of posterior-superior irreparable rotator cuff tears.

Abstract

Posterior-superior irreparable rotator cuff tears (PSIRCTs) are a significant challenge in managing active individuals without arthritis traditional latissimus dorsi (LD) transfer is prone to retear due to the tendon's thinness and yields suboptimal outcomes with subscapularis tears. This study evaluates the clinical outcomes of fully arthroscopic combined LD and teres major transfer in patients with PSIRCTs without arthritis. This retrospective study included patients who underwent fully arthroscopic LD teres major (LDTM) transfer for PSIRCTs from January 2018 to February 2022. Inclusion criteria included persistent with irreparable supraspinatus and infraspinatus tears and minimal glenohumeral arthritis. Excluded were patients who were lost to follow-up or had less than 2 years of follow-up. Clinical outcomes were assessed using visual analog scale, Simple Shoulder Test, Subjective Shoulder Value, American Shoulder and Elbow Surgeons score, Activities of Daily Living requiring active External Rotation score, and range of motion. Progression of arthritis was evaluated, and any complications were recorded. A total of 90 patients were included, with a mean age of 64.6 years and an average follow-up period of 36.6 months. Significant improvements were observed in visual analog scale and all patient-reported outcome measures, with P < .001. Significant improvements were observed in forward elevation (124°-153°), abduction (88°-137°), external rotation at the side (17°-34°), and external rotation at 90° abduction (45°-52°). Three patients experienced progression of arthritis, leading to conversion to reverse total shoulder arthroplasty. No retear of transferred LDTM were found. Four cases of axillary nerve palsy were reported, with 2 being transient. The fully arthroscopic LDTM transfer provides significant pain relief and functional improvements in managing PSIRCTs. There was significant improvement in all patient-reported outcome measures and shoulder range of motion. Three patients developed progression of arthritis, leading to conversion to reverse total shoulder arthroplasty.