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Joint-preserving treatment for global irreparable rotator cuff tears: combined anterior Latissimus dorsi and Teres major tendon transfer

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

Abstract

Introduction

Treating global irreparable rotator cuff tears (GIRCTs) that involve both antero-and postero-superior cuff tendon tears could be a challenging problem. There has been limited joint-preserving treatment options in high-demand patients with minimal glenohumeral arthritis. The study aims to assess the clinical outcome of combined anterior latissimus dorsi and teres major tendon (aLDTM) transfer for patients with both GIRCTs and minimal glenohumeral arthritis.

Materials and methods

This retrospective study included patients who underwent combined aLDTM transfer for GIRCTs between 2018 May and 2020 October. Clinical outcomes include pain VAS, Constant, American Shoulder and Elbow Society (ASES), University of California Los Angeles (UCLA), activities of daily living requiring active internal rotation (ADLIR) score, active range of motion (aROM), strength, rates of pseudoparalysis or pseudoparesis reversal and return to work. Radiographic assessment included the acromiohumeral distance (AHD), Hamada grade, and transferred tendon integrity at final follow-up.

Results

23 patients (mean age: 64.7 ± 5.9 years [55–74]) were included and the mean follow-up period was 28.2 ± 4.3 [24‒36] months. Postoperatively, VAS, Constant, ASES, UCLA, and ADLIR scores significantly improved at final follow-up (P < .001). Postoperative aROM was significantly improved in forward elevation (FE) to 129° ± 29°, abduction (ABD) to 105° ± t3°, and internal rotation (IR) at back to 5.9 ± 2.5. Strength of both FE and IR were also significantly improved (P < .001). Patients with preoperative pseudoparalysis (2 of 4 patients) and pseudoparesis (6 of 6 patients) experienced a reversal. No significant change in AHD and hamada grade was confirmed at final follow-up. 3 patients experienced partial tear of the transferred tendon.

Conclusions

In this study, we found significant improvement in clinical outcomes with no significant progression of arthritis by final follow-up. The aLDTM transfer could be an alternative choice of joint-preserving treatment option for young and active patients with GIRCTs and minimal glenohumeral arthritis. However, large and long-term studies should be conducted to establish its adequacy.

Study design

Case series.

Level of evidence

IV.

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Data availability

Data available on request due to privacy/ethical restrictions.

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Acknowledgements

The authors would like to express gratitude to Seung Hak Choi for help of collecting clinical data.

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No funds, grants, or other support was received.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea

    Chang Hee Baek, Bo Taek Kim, Jung Gon Kim & Seung Jin Kim

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  1. Chang Hee Baek
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Correspondence to Chang Hee Baek.

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Conflict of interest

Chang Hee Baek, Bo Taek Kim, Jung Gon Kim, Seung Jin Kim: The authors have no relevant financial or non-financial interest disclose.

Ethical approval

The protocol of this study was approved by Ministry of Health and Welfare institutional review board. [Institutional Review Board (No. P01-202304-01-022)]. Procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Baek, C.H., Kim, B.T., Kim, J.G. et al. Joint-preserving treatment for global irreparable rotator cuff tears: combined anterior Latissimus dorsi and Teres major tendon transfer. Arch Orthop Trauma Surg 144, 1473–1483 (2024). https://doi.org/10.1007/s00402-023-05196-z

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