Massive rotator cuff tears (MRCTs) represent up to 20% of all rotator cuff tears and, if left untreated, may result in cuff tear arthropathy, which causes shoulder disability owing to the loss of glenohumeral biomechanics and progressive arthritis. A variety of treatments have been proposed. Among the surgical options, in the case of an irreparable tendon lesion without osteoarthritis in younger patients, joint -preservation techniques are needed, and tendon transfer represents a reconstructive technique that may restore power and function. The aim of this review is to summarize the indications, outcomes, and complications of tendon transfer techniques to treat irreparable MRCT. The goal of each tendon transfer is to restore the force couples in the shoulder. Latissimus dorsi tendon transfer is used for massive posterosuperior rotator cuff tears involving the supraspinatus and infraspinatus with an intact or reparable subscapularis tendon. Teres major tendon transfer is used for irreparable posterosuperior cuff tears in patients with isolated infraspinatus deficiency. The lower trapezius has a force vector in the same direction as the infraspinatus, and it is often used in posterosuperior cuff tears. Pectoralis major tendon transfer is indicated for irreparable anterosuperior cuff tears or isolated subscapularis tears. Overall, satisfactory functional results can be expected even though the normal kinematics of the shoulder are not always restored. Careful selection of both the patient and the type of tendon transfer to be performed is necessary to optimize the outcome of this surgery.

Indications, outcomes, and complications of tendon transfer for massive irreparable rotator cuff tears

Galasso O.;
2024-01-01

Abstract

Massive rotator cuff tears (MRCTs) represent up to 20% of all rotator cuff tears and, if left untreated, may result in cuff tear arthropathy, which causes shoulder disability owing to the loss of glenohumeral biomechanics and progressive arthritis. A variety of treatments have been proposed. Among the surgical options, in the case of an irreparable tendon lesion without osteoarthritis in younger patients, joint -preservation techniques are needed, and tendon transfer represents a reconstructive technique that may restore power and function. The aim of this review is to summarize the indications, outcomes, and complications of tendon transfer techniques to treat irreparable MRCT. The goal of each tendon transfer is to restore the force couples in the shoulder. Latissimus dorsi tendon transfer is used for massive posterosuperior rotator cuff tears involving the supraspinatus and infraspinatus with an intact or reparable subscapularis tendon. Teres major tendon transfer is used for irreparable posterosuperior cuff tears in patients with isolated infraspinatus deficiency. The lower trapezius has a force vector in the same direction as the infraspinatus, and it is often used in posterosuperior cuff tears. Pectoralis major tendon transfer is indicated for irreparable anterosuperior cuff tears or isolated subscapularis tears. Overall, satisfactory functional results can be expected even though the normal kinematics of the shoulder are not always restored. Careful selection of both the patient and the type of tendon transfer to be performed is necessary to optimize the outcome of this surgery.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11386/4895855
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