Management Of Massive Rotator Cuff Tears Involving Irreparable Subscapularis Tear By Arthroscopically Assisted Latissimus Dorsi Transfer: Clinical Results.

Abstract

This study aims to evaluate the outcomes of arthroscopically assisted latissimus dorsi (LD) transfer for massive rotator cuff tears involving irreparable subscapularis tendon tears. This retrospective cohort study was conducted at a specialized Shoulder Unit in Paris from June 2014 to January 2023 to evaluate outcomes of LD transfer for irreparable subscapularis tendon tears. The primary outcome was the Constant score; secondary outcomes included VAS, SSV, and satisfaction levels. A subgroup analysis was performed to compare postoperative outcomes between patients with reparable versus irreparable supraspinatus tendons. Additionally, all complications were recorded. Twenty-one patients, predominantly male (90.5%) with a mean age of 58.6 years (SD 8.2), were included. Most had the right shoulder affected (85.7%), with a mean follow-up of 15.3 months (SD 11.9). The mean Constant score significantly increased from 37.4 ± 9.7 pre-operatively to 70.5 ± 11 post-operatively (gain of 31.5 ± 20, p < .001). The mean VAS score decreased from 4.4 ± 1.9 to 1.5 ± 1.5 (reduction of -2.7 ± 2.6, p < .001). The mean SSV improved from 49.5 ± 14.3 to 76 ± 11.4 (gain of 25.2 ± 25, p < .001). Satisfaction levels were high, with 16 patients very satisfied, 4 satisfied, and 1 disappointed. Subgroup analysis showed a trend toward better outcomes in the reparable supraspinatus group, although these differences were not statistically significant. Three complications (14.3%) occurred: one surgical failure requiring revision to reverse shoulder arthroplasty, one persistent painful shoulder without functional improvement, and one infection that was resolved with treatment. The Gerber test remained positive in 9 patients (42.9%), and the Belly Press test remained positive in 3 patients (14.3%). LD transfer for irreparable subscapularis tendon tears leads to significant improvements in shoulder function, pain reduction, and patient satisfaction. While it offers a viable option, residual subscapularis insufficiency persists in a subset of patients.