Outcome of Anterior Latissimus Dorsi with Teres Major and Posterior Lower Trapezius Tendon Transfer for Global Irreparable Rotator Cuff Tears.

Introduction: Global irreparable rotator cuff tears (GIRCTs) without arthritis pose significant challenges for shoulder management. This study evaluates the clinical outcomes of dual-tendon reconstruction, combining anterior latissimus dorsi-teres major (LDTM) and posterior lower trapezius tendon (LTT) transfers, in patients with GIRCTs without arthritis.

Methods: A retrospective analysis was conducted on patients who underwent dual tendon transfer surgery for GIRCTs without arthritis. Clinical assessment included pain levels (VAS), patient-reported outcome measures (Constant score, ASES, UCLA, and SANE), active range of motion (ROM), and shoulder strength preoperatively and at final follow-up. Radiological assessments were performed to evaluate tendon integrity and glenohumeral joint status.

Results: At the final follow-up, significant improvements were observed in patient-reported outcomes, pain relief, and ROM in all directions. The patients demonstrated improved shoulder strength, with no significant change in the acromiohumeral distance (AHD) or Hamada grading system for arthritis. Two patients experienced partial re-tears of the LTT transfer: one due to trauma and the other spontaneously at the humeral footprint; both were managed conservatively. One patient experienced minor progression of arthritis, but it was clinically insignificant.

Conclusion: Dual reconstruction, combining LDTM and LTT transfers, provides significant pain relief, functional improvement, and preserved joint mechanics for patients with GIRCTs without arthritis. This technique is a promising joint-preserving option that may delay the need for RTSA, offering an alternative for patients with intact cartilage and GIRCTs.

Level of evidence: IV; retrospective case-series study.