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Review
. 2018 Mar;11(1):141-149.
doi: 10.1007/s12178-018-9468-1.

The Role of Tendon Transfers for Irreparable Rotator Cuff Tears

Nicholas J Clark  1 , Bassem T Elhassan  2
Affiliations
Review

The Role of Tendon Transfers for Irreparable Rotator Cuff Tears

Nicholas J Clark et al. Curr Rev Musculoskelet Med. 2018 Mar.

Abstract

Purpose of review: This review aims to describe the tendon transfer options for treating irreparable rotator cuff tears (RCTs). Options for transfer include latissimus dorsi and lower trapezius transfers for posterior-superior RCTs and pectoralis major and latissimus dorsi transfer for anterior-superior RCTs.

Recent findings: While the latissimus dorsi tendon transfer has historically been performed for posterosuperior RCTs, the lower trapezius transfer is a more anatomic option and has demonstrated promising results in recent studies. Similarly, the pectoralis major transfer has historically been the tendon transfer of choice for anterosuperior RCTs. However, the latissimus dorsi tendon transfer has recently been shown to be a safe and anatomic tendon transfer for subscapularis insufficiency. The treatment of irreparable RCTs involves complex decision making. Tendon transfer procedures can restore the glenohumeral joint force couples, allowing restoration of near-normal shoulder kinematics. Benefits include reliable pain relief, increased function, and increased strength. Proper selection of donor tendon is crucial, and the principles of tendon transfer procedures must be adhered to for maximal benefit.

Keywords: Latissimus dorsi; Lower trapezius; Pectoralis major; Rotator cuff tear; Tendon transfer.

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Conflict of interest statement

Conflict of Interests

The authors whose names are listed above certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Anteroposterior (AP) radiograph showing superior migration of the humeral head due to massive rotator cuff tear. Additionally, there is significant glenohumeral arthritis present
Fig. 2
Fig. 2
Sagittal T1-weighted MRI view of scapula demonstrating a massive anterior-superior rotator cuff tear with fatty degeneration of the supraspinatus and infraspinatus musculature
Fig. 3
Fig. 3
Latissimus dorsi anatomy highlighting the muscle’s origin and insertion. This figure also shows the blood supply of latissimus dorsi muscle provided by the thoracodorsal artery
Fig. 4
Fig. 4
Origin and insertion of the trapezius muscle, highlighting the lower trapezius. Incisions for the open lower trapezius transfer are shown with solid lines. A 5-cm incision is made 1-cm medial to the medial scapular spine as shown here. The tendon will be passed through the area designated by the dashed line. Note the close proximity of the spinal accessory nerve (CN XI) to the incision. The nerve lies below the fascia of the trapezius, making superficial dissection in this region safe. Used with permission of Mayo Foundation for Medical Education and Research. All rights reserved
Fig. 5
Fig. 5
a Tendon augmentation using Achilles tendon allograft for length. The thin portion of the Achilles allograft is attached to the tendinous portion of the lower trapezius using two nonabsorbable sutures. b Prepared lower trapezius augmented with Achilles allograft. Used with permission of Mayo Foundation for Medical Education and Research. All rights reserved
Fig. 6
Fig. 6
Intraoperative image of lower trapezius (star) augmented with Achilles allograft. b Preparing tendon for transfer through previously created path. The clamp is passed deep to the posterior deltoid towards the medial wound. c The tendon is retrieved through the lateral wound
See this image and copyright information in PMC

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