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Latissimus dorsi and teres major tendon transfer for irreparable anterosuperior rotator cuff tear improves kinematics and internal rotation compared to latissimus dorsi tendon transfer

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Latissimus dorsi and teres major (LDTM) tendon transfer has demonstrated better clinical outcomes compared to Latissimus dorsi (LD) transfer for irreparable anterosuperior cuff (subscapularis/supraspinatus) tears; however, the biomechanical effects of these procedures are unknown. Therefore, the objective of this study was to compare kinematics and internal rotation of LDTM transfer to LD transfer for anterosuperior cuff tear.

Methods

Eight cadaveric shoulders were tested in four conditions; (1) intact, (2) anterosuperior rotator cuff tear, (3) LDTM transfer, and (4) LD transfer. Glenohumeral kinematics and internal rotation at 0°, 30°, and 60° of glenohumeral abduction in the scapular plane were measured. Muscle loading was applied based on physiological cross-sectional area ratios with three muscle loading conditions to simulate potentially increased tension due to the advanced insertion site of the transferred tendons.

Results

The anterosuperior rotator cuff tear leads to a significant superior shift of the humeral head compared to intact at 0° and 30° abduction (p < 0.039). Both the LDTM (p < 0.047) and LD transfers (p < 0.032) significantly shifted the humeral head inferiorly compared to the tear condition.; however, the LDTM transfer shifted the head in the anteroinferior direction compared to the LD transfer at 60° abduction and 30° ER (p < 0.045). Both LDTM and LD transfer significantly increased internal resting rotation (p < 0.008) and maximum internal rotation (p < 0.008) compared to anterosuperior rotator cuff tear and intact at 30° and 60° abduction. LDTM transfer resulted in a significant internal resting rotation compared with the LD transfer at 30° abduction with double muscle loading (p = 0.02). At 0° abduction, the LDTM transfer (p < 0.027) significantly increased maximum internal rotation compared to anterosuperior rotator cuff tear and intact.

Conclusion

Although both LDTM and LD tendon transfer improved the abnormal humeral head apex position and internal rotation compared with the tear condition, the LDTM transfer was biomechanically superior to the LD transfer in a cadaveric model.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

Funding for this study was provided by Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea. The funding source did not play a role in the investigation.

Author information

Authors and Affiliations

  1. Orthopedic Biomechanics Laboratory, Congress Medical Foundation, 800 S Raymond Ave, Pasadena, CA, 91105, USA

    Gyu Rim Baek, Andrew P. Nakla, Daniel Kwak, Min-Shik Chung, Michelle H. McGarry, Gregory J. Adamson & Thay Q. Lee

  2. Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-Si, Jeollanam-Do, Republic of Korea

    Jung Gon Kim

Authors
  1. Gyu Rim Baek
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Contributions

All authors contributed to the study’s conception and design. Methodology: Michelle H. McGarry, MS; Gregory J. Adamson, MD; Thay Q Lee, PhD; Data collection and analysis were performed by Gyu Rim Baek, BS; Jung Gon Kim, MD; Andrew P. Nakla, BS; Daniel Kwak, BA; Min-Shik Chung, BS, Michelle H. McGarry, MS. Funding acquisition: Gregory J. Adamson, MD1; Thay Q Lee, PhD1 The first draft of the manuscript was written by Gyu Rim Baek, BS and Jung Gon Kim, MD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Investigation performed at Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.

Corresponding author

Correspondence to Thay Q. Lee.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Institutional review board approval was not required for this cadaveric study.

Informed consent

NA as this was a basic science cadaveric study.

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Baek, G.R., Kim, J.G., Nakla, A.P. et al. Latissimus dorsi and teres major tendon transfer for irreparable anterosuperior rotator cuff tear improves kinematics and internal rotation compared to latissimus dorsi tendon transfer. Arch Orthop Trauma Surg 143, 4731–4739 (2023). https://doi.org/10.1007/s00402-022-04735-4

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