Tendon transfers for massive rotator cuff tears

Abstract

• Massive rotator cuff tears (MRCTs) present a particular challenge due to high rates of retear that can range from 18 to 94%, failure of healing after repair, and potential for irreparability. • Management of MRCTs must take into consideration the patient’s characteristics, clinical examamination and expectation, number and quality of muscle tendons units involved. • Conservative treatment, arthroscopic long head of the biceps tenotomy, cuff debridement, partial repair, and superior capsule reconstruction are viable solutions to treat selected patients. • The goal of tendon transfers is to achieve stable kinematic by restoring rotational strength and force coupling of the shoulder joint. • The ideal candidate is a young, motivated patient with small degenerative changes of the glenohumeral joint, a massive irreparable cuff tear, significant atrophy, fatty infiltration, and functional deficit. • Patients with posterosuperior massive tears have impaired shoulder function with external rotation weakness and eventually lag sign If the teres minor is affected. • Latissimus dorsi transfer is the most used with results lasting for long follow-up and lower Trapezius transfer is becoming a surgical option. For anterosuperior tears, there is still controversial if pectoralis major is the best option when compared to latissimus dorsi although this last has a similar vector force with the supraspinatus tendon. • Complications associated with tendon transfers include neurovascular injury, infection, and rupture of the transferred tendon.