Effect of preoperative subscapularis status on functional recovery after posterior latissimus dorsi tendon transfer for posterior-superior irreparable rotator cuff tears.

Abstract

Posterior latissimus dorsi (LD) transfer is widely used to treat posterior-superior irreparable rotator cuff tears (PSIRCTs), but the impact of subscapularis integrity on postoperative outcomes remains debated. This study aimed to evaluate the effect of subscapularis integrity on clinical and radiologic outcomes following arthroscopic-assisted posterior LD transfer. This retrospective study included patients who underwent arthroscopic-assisted posterior LD transfer for PSIRCTs and were classified into Preoperative Subscapularis Intact and Preoperative Subscapularis Tear groups. Surgical indications included PSIRCTs, intact or repairable subscapularis, and minimal glenohumeral arthritis. Clinical assessments comprised VAS, Constant score, ASES score, and active range of motion (ROM). Radiologic evaluations included acromiohumeral distance (AHD), Hamada grade, and integrity of the transferred tendon. Postoperative complications and the achievement of minimal clinically important differences (MCID) were also recorded. A total of 53 patients were included, classified into the Preoperative Subscapularis Intact group (n = 34) and the Preoperative Subscapularis Tear group (n = 19). At a mean follow-up of 62.9 ± 12.9 months, both groups demonstrated significant improvements in pain, patient-reported outcome measures (PROMs), and range of motion (ROM). Patients with an intact subscapularis achieved higher postoperative Constant scores (70.7 ± 8.9 vs. 62.3 ± 8.9, p = 0.002) and ASES scores (75.5 ± 8.8 vs. 66.7 ± 8.8, p = 0.001) than those with tears. Retear rates (17.6% vs. 26.3%, p = 0.465) and overall complications were similar between groups. Radiographically, the acromiohumeral distance decreased and the Hamada grade increased slightly in both groups, consistent with previously reported outcomes. Posterior LD transfer provides significant improvements in pain, function, and range of motion for patients with PSIRCTs. Although both groups demonstrated meaningful improvements, patients with an intact preoperative subscapularis tended to achieve significantly higher Constant and ASES scores compared with those with preoperative subscapularis tears. Retrospective Case-series.