Adding Teres Major Transfer to Arthroscopic-Assisted Posterior Latissimus Dorsi Transfer Provides Superior Outcomes for Posterosuperior Irreparable Rotator Cuff Tears.

Abstract

To compare the clinical and radiologic outcomes of arthroscopic-assisted latissimus dorsi transfer (LDT) and arthroscopic-assisted posterior latissimus dorsi and teres major (pLDTM) transfer in patients with posterosuperior irreparable rotator cuff tears (PSIRCTs). We retrospectively reviewed patients with PSIRCTs who underwent LDT or pLDTM transfer between January 2017 and December 2020 and were followed up for at least 2 years. Clinical outcomes were evaluated based on pain, patient-reported outcome scores, active range of motion, and active range-of-motion strength. Radiologic outcomes were evaluated by arthritic changes in the glenohumeral joint and transferred tendon integrity. The acromiohumeral distance and Hamada classification were evaluated on true anteroposterior radiographs. Hamada grade 3, 4, or 5 at last follow-up indicated the progression of osteoarthritis (OA). Transferred tendon integrity was evaluated on magnetic resonance imaging with the Sugaya classification. The LDT and pLDTM groups included 48 and 32 patients, respectively, with no difference in the mean follow-up period between the LDT group (59.0 ± 9.6 months; range, 48-72 months) and the pLDTM group (56.5 ± 8.4 months; range, 42-72 months; P = .697). Significantly improved clinical outcomes were observed in both groups. The postoperative Activities of Daily Living Requiring Active External Rotation (ADLER) score (20.2 ± 6.7 vs 24.5 ± 6.3, P = .002), rate of achievement of the minimal clinically important difference for the ADLER score (56.3% vs 81.3%, P = .029), postoperative external rotation (ER) (33.8° ± 5.4° vs 39.4° ± 5.9°, P = .043), and postoperative ER strength (19.5 ± 4.6 N vs 23.5 ± 4.1 N, P < .001) were significantly better in the pLDTM group. Regarding radiologic outcomes, the rate of OA progression (42.3% vs 18.8%, P = .049) was significantly higher in the LDT group. There was no significant difference in transferred tendon retear rate between the 2 groups. At medium-term follow-up, pLDTM transfer for PSIRCTs results in improved ADLER scores, ER, and ER strength with slower OA progression compared with LDT. Level III, retrospective comparative study.