Arthroscopically Assisted Posterior Latissimus Dorsi and Teres Major Transfer Can Alleviate Pain and Improve Shoulder Function.

Abstract

Purpose: To evaluate the efficacy of arthroscopically assisted latissimus dorsi-teres major (LD-TM) transfer in patients with posterosuperior irreparable rotator cuff tears (PSIRCTs) without glenohumeral arthritis.

Methods: This retrospective study reviewed patients from 2 centers who underwent arthroscopically assisted LD-TM transfer: center A (between June 2014 and June 2020) and center B (between October 2014 and December 2017). The inclusion criteria consisted of patients with PSIRCTs without glenohumeral arthritis and a minimum 2-year follow-up. The exclusion criteria were combined biceps superior capsular reconstruction, missing clinical data, or loss to follow-up. Patient outcomes were assessed using the visual analog scale score, range of motion (ROM), progression of arthritis, and various patient-reported measures, including the Simple Shoulder Test (SST) score, Subjective Shoulder Value (SSV), Activities of Daily Living That Require Active External Rotation (ADLER) score, and American Shoulder and Elbow Surgeons (ASES) score.

Results: After the exclusion of 15 patients, 96 patients (26 from center A and 70 from center B) were included. The mean age was 64.0 ± 9.4 years (range, 38-83 years), with a mean follow-up of 43.3 ± 18.3 months (range, 24-101 months). Significant improvements were observed in the SST score, SSV, ADLER score, and ASES score (P < .001 for all). Significant ROM improvements were noted in forward elevation, abduction, and external rotation. Clinically meaningful improvements (minimal clinically important difference, calculated by 0.5 standard deviation method) were seen in 73.9% of patients for the SST score, 90.6% for the SSV, 73.5% for the ADLER score, and 79.1% for the ASES score. A total of 16 patients experienced retears, and 3 patients required conversion to reverse total shoulder arthroplasty because of persistent pain unresponsive to conservative treatment. No significant differences in outcomes or complication rates were observed between the 2 centers.

Conclusions: Arthroscopically assisted LD-TM transfer significantly relieved pain and improved functional outcomes in patients with PSIRCTs, as shown by significant improvements in pain scores, patient-reported outcome measures, and ROM. This study supports that arthroscopically assisted LD-TM transfer is an effective treatment option for managing PSIRCTs.

Level of evidence: Level IV, retrospective case series.