Return to work and sports after posterior latissimus dorsi transfer for posterior superior irreparable rotator cuff tears

Abstract

Background

Posterior superior irreparable rotator cuff tears (PSIRCTs) cause substantial functional limitations, particularly in individuals performing physically demanding work or participating in sports. The purpose of this study was to evaluate the rate and timing of return to work (RTW) and return to sports (RTS) following posterior latissimus dorsi (LD) transfer in patients with PSIRCTs and to identify factors associated with successful return. It was hypothesized that patients would demonstrate high RTW and RTS rates.

Methods

This retrospective study included patients who underwent posterior LD transfer for PSIRCTs between April 2012 and June 2020. RTW and RTS rates, timing, and levels of return were assessed using structured questionnaires. Clinical outcomes, including visual analog scale, American Shoulder and Elbow Surgeons, Constant, and Single Assessment Numeric Evaluation scores, as well as active range of motion (ROM), were evaluated pre-operatively and post-operatively. Multivariable analysis was used to identify factors associated with RTW and RTS. Patients who had undergone revision surgery, were lost to follow-up, or had unavailable clinical or radiological data were excluded.

Results

After excluding 15 patients, 83 patients were included (mean age 61.9 ± 5.3 years; mean follow-up 65.3 ± 13.9 months). Pre-operative occupational demand was classified according to the Dictionary of Occupational Titles criteria as light, medium, or heavy work based on physical workload requirements. Overall, 85.5% of patients returned to work, including 56.6% at their previous work level and 28.9% at a reduced level, while 14.4% did not return. In subgroup analysis, patients with lighter workloads demonstrated higher RTW rates (95.2% vs. 92.3% vs. 75.0%) and shorter return times (4.1 ± 1.1 vs. 4.1 ± 1.2 vs. 5.6 ± 1.6 months) compared with those performing heavy labor. The overall RTS rate was 89.7%, with 72.1% achieving complete RTS and 27.8% partial RTS. On multivariable analysis, higher work intensity and tendon retear were significantly associated with RTW, whereas tendon retear was the only significant predictor of RTS.

Conclusion

Posterior LD transfer for PSIRCTs was associated with high rates of RTW and RTS among patients without major post-operative failure. Higher occupational demand was associated with delayed and less complete RTW, while tendon integrity was associated with both RTW and RTS. These findings should be interpreted cautiously because of retrospective design, self-reported activity outcomes, limited subgroup sizes, and exclusion of patients requiring revision surgery or conversion to reverse shoulder arthroplasty.