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. 2025 Jan 17;20(1):61.
doi: 10.1186/s13018-025-05496-7.

Efficacy of latissimus dorsi and teres major tendon transfer in anterosuperior irreparable rotator cuff tears and posterosuperior irreparable rotator cuff tears

Chang Hee Baek  1 , Chaemoon Lim  2 , Jung Gon Kim  2 , Bo Taek Kim  2 , Seung Jin Kim  2
Affiliations

Efficacy of latissimus dorsi and teres major tendon transfer in anterosuperior irreparable rotator cuff tears and posterosuperior irreparable rotator cuff tears

Chang Hee Baek et al. J Orthop Surg Res. .

Abstract

Background: There are various options of tendon transfer according to the different types of irreparable rotator cuff tears (IRCTs). However, there were no clear treatment options for the IRCTs involving the anterior, superior and posterior rotator cuff tears (global IRCTs). Latissimus dorsi and teres major (LDTM) could be transferred anteriorly or posteriorly in global IRCTs. The purpose of this study is to evaluate the efficacy of LDTM transfer in anterosuperior IRCTs (ASIRCTs) and posterosuperior IRCTs (PSIRCTs).

Methods: The patients who underwent anterior LDTM (aLDTM) transfer (aLDTM group, n = 35) for ASIRCTs or pLDTM transfer (aLDTM group, n = 33) for PSIRCTs between January 2017 and December 2020 were reviewed retrospectively. Clinical and functional outcomes were evaluated based on pain, patient-reported outcome scores, active range of motion (aROM) and strength of aROM. Radiological outcomes were evaluated using arthritic changes in the glenohumeral joint and transferred tendon integrity. Arthritic changes in the glenohumeral joint were evaluated using the acromiohumeral distance (AHD) and Hamada classification on the true anteroposterior radiograph.

Results: No significant intergroup difference was confirmed in patient demographics except for preoperative fat infiltration grade of subscapularis and infraspinatus. The postoperative Constant score, and University of California and Los Angeles (UCLA) score of aLDTM group were significantly higher than that of pLDTM group (p < 0.001 and < 0.001, respectively). Moreover, the achievement of minimal clinically important difference (MCID) for American Shoulder and Elbow Surgeons score and UCLA score showed a significant difference between two groups (p = 0.021 and 0.042, respectively). The postoperative forward elevation (FE) was significantly higher in aLDTM group (p = 0.046). The postoperative FE strength and abduction strength were significantly higher in aLDTM group (p = 0.001 and 0.025, respectively). Moreover, the mean improvement of internal rotation strength in aLDTM group was significantly higher than mean improvement of external rotation strength in pLDTM group (p = 0.011). The progression of arthritic change was significantly higher in pLDTM group (p = 0.002).

Conclusion: Although LDTM transfer is an effective and safe treatment option for ASIRCTs and PSIRCTs, LDTM transfer is more effective for ASIRCTs than PSIRCTs due to its biomechanical advantage and tendon transfer principles.

Level of study: Level III.

Keywords: Irreparable rotator cuff tears; Latissimus dorsi and teres major transfer.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: This study was approved by the Institutional Review Board (ethics committee) of the Ministry of Health and Welfare (IRB No. P01-202411-01-005). The institutional review board permitted this study and exempted the necessity for informed consent because this study was performed retrospectively. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Harvest of LDTM tendon for aLDTM transfer. The latissimus dorsi and teres major tendon (asterisk) was harvested from the insertion in a periosteal manner without separating the individual tendons. LDTM; latissimus dorsi and teres major, aLDTM; anterior LDTM
Fig. 2
Fig. 2
Fixation of aLDTM transfer. The latissimus dorsi and teres major (LDTM, asterisk) tendon was attached just lateral to the biceps groove and distal to the lateral edge of the greater tuberosity (GT). Fixing the LDTM tendon just distal to the GT positioned the tendon diagonally and more tautly, achieving tendon tensioning and avoiding axillary nerve impingement. aLDTM; anterior LDTM, GT; greater tuberosity, BG; biceps groove, LT; lesser tuberosity
Fig. 3
Fig. 3
Harvest of LDTM tendon for pLDTM transfer. The latissimus dorsi and teres major tendon (asterisk) was harvested from the insertion in a periosteal manner without separating the individual tendons. LDTM; latissimus dorsi and teres major, pLDTM; posterior LDTM
Fig. 4
Fig. 4
Introducing atissimus dorsi and teres major tendon into the subacromial space. The latissimus dorsi and teres major tendon (asterisk) were introduced into the subacromial space using the inflated balloon of the urinary catheter
Fig. 5
Fig. 5
Fixation of pLDTM transfer. The latissimus dorsi and teres major tendon (asterisk) was attached to the supraspinatus footprint and positioned immediately posterior to the bicep groove. pLDTM; posterior LDTM
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