Soft tissue reconstruction techniques for irreparable anterosuperior rotator cuff tears: A systematic review of clinical outcomes.

Abstract

Irreparable anterosuperior (AS) rotator cuff tears involving the subscapularis and supraspinatus cause significant shoulder dysfunction, instability, and pain. Surgical options such as pectoralis major (PM), pectoralis minor (Pm), and latissimus dorsi (LD) transfers aim to restore shoulder biomechanics, but the optimal technique remains uncertain. This systematic review evaluated clinical outcomes of soft tissue reconstruction for irreparable AS tears. Following PRISMA guidelines, Ovid MEDLINE, Embase, Emcare, and PubMed were searched. Eligible studies included randomized trials, cohort studies, and case series (≥10 patients). Methodological quality was assessed using the MINORS criteria. Eight studies (350 patients) evaluating PM, Pm, LD, and combined latissimus dorsi-teres major (LDTM) transfers were included. Pm and LD transfers demonstrated the lowest failure (1.0%, 0%) and complication rates (0%, 5.6%). PM and LDTM transfers showed higher failure (12.2%) and complication rates (13.5%, 1.6%). All techniques improved patient-reported outcomes. Improvements in range of motion were most consistent in shoulder elevation, while rotational gains were smaller and variably reported. Soft tissue reconstruction for irreparable AS rotator cuff tears is associated with improved clinical outcomes. Pm and LD transfers appear to offer a favorable balance of functional improvement and safety, although study heterogeneity limits definitive comparison.