Current Options in Tendon Transfers for Irreparable Posterosuperior Rotator Cuff Tears

Massive irreparable posterosuperior rotator-cuff tears are debilitating lesions that usually require surgical treatment. Even though there is no consensus regarding the best surgical technique, tendinous transfers around the shoulder are the most commonly performed procedures. The latissimus dorsi tendon remains the most commonly used, but different modifications to the original technique have been shown to minimize complications and to improve functional results and satisfaction. Other techniques, such as the transfer of the lower trapezius tendon, are promising and should be considered, especially for patients with isolated loss of external rotation. The present paper is a literary review regarding tendon transfers for irreparable posterosuperior rotator-cuff tears.

Keywords
shoulder; rotator cuff injuries; tendon transfers; review

Authorship

Caio Santos Checchia Address for correspondence Caio Santos Checchia, Grupo de Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesario Mota Junior, 112, Consolação, São Paulo, SP, 01221-020, Brazil (e-mail: caio.checchia@gmail.com).

Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, BrasilFaculdade de Ciências Médicas da Santa Casa de São PauloBrasilSão Paulo, BrasilDepartamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil

https://orcid.org/0000-0003-1562-9795

Luciana Andrade da Silva

Guilherme do Val Sella

Marcelo Fregoneze

Alberto Naoki Miyazaki

Address for correspondence Caio Santos Checchia, Grupo de Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesario Mota Junior, 112, Consolação, São Paulo, SP, 01221-020, Brazil (e-mail: caio.checchia@gmail.com).

Conflict of interests

The authors declare to have no conflict of interests.

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Figures

Figures (5)

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Fig. 1
(A-C) Latissimus dorsi transfer using a double-incision technique. Representation of a right shoulder. (A) Posterior view. A posterior incision is made over the lateral border of the palpable latissimus dorsi belly, which is then separated from the more superior and medial teres major muscle. (B) Posterior view. The tendon is detached from the humerus and then is transported to the subacromial space with a clamp that is brought from the superior to the posterior incision, placed between the posterior deltoid and the long head of the triceps muscle. (C) Superior view. The transferred tendon is then anchored to an osseous trough in the superolateral humeral head (over-the-top placement), and any remaining cuff is sutured to the transfer.

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Fig. 2
(A, B) Postoperative radiographs after a latissimus dorsi transfer with 3 metal markers (placed at 2 cm, 4 cm and 6 cm from the tip of the tendon). The asterisks indicate the metallic anchor from a previous (failed) rotator-cuff repair. (A) Anteroposterior view. (B) Scapular profile view.

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Fig. 3
(A, B) Postoperative rupture of a latissimus dorsi tendon transfer. Note the increased distance between the intact first marker (1st) and the displaced second and third (2nd and 3rd) metal markers. The asterisks indicate metallic anchors from a previous (failed) rotator-cuff repair. Note that the calcified lesion in the proximal part of the humerus is an enchondroma, not at all related to the procedure or the rotator-cuff tear. (A) Anteroposterior view. (B) Scapular profile view.

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Fig. 4
(A-D) Latissimus dorsi tendon transfer elongated and reinforced with a tendinous allograft and performed through an isolated deltopectoral approach, as described by Miyazaki et al.⁶¹61 Miyazaki AN, Checchia CS, LopesWC, Fonseca Filho JM, do Val Sella G, Silva LA. Transferência tendínea do grande dorsal com enxerto tendíneo homólogo para as lesões irreparáveis do manguito rotador: técnica cirúrgica*. Rev Bras Ortop 2019;54(01):99–103 (A) Figure depicting tendon preparation before transfer. (B) Allograft preparation. (C) After passing the transfer behind the humerus. (D) Figure depicting final configuration of the latissimus dorsi tendon. Abbreviations: AG, allograft; TRI, triceps, LD, latissimus dorsi; RCT, rotator-Cuff Tear; LHB, long head of the biceps; TM, teres major; sub, subscapularis.

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Fig. 5
(A-C) Drawings of the right shoulder. The line of pull from the lower trapezius (LT) more closely replicates the one from the infraspinatus (IS) than the one generated by the latissimus dorsi (LD). The line of pull from the LD closely replicates the line of pull from the subscapularis (SSCP). (A) Posterior view. (B) Anterior view. (C) Medial view.

Fig. 1 (A-C) Latissimus dorsi transfer using a double-incision technique. Representation of a right shoulder. (A) Posterior view. A posterior incision is made over the lateral border of the palpable latissimus dorsi belly, which is then separated from the more superior and medial teres major muscle. (B) Posterior view. The tendon is detached from the humerus and then is transported to the subacromial space with a clamp that is brought from the superior to the posterior incision, placed between the posterior deltoid and the long head of the triceps muscle. (C) Superior view. The transferred tendon is then anchored to an osseous trough in the superolateral humeral head (over-the-top placement), and any remaining cuff is sutured to the transfer.

Fig. 2 (A, B) Postoperative radiographs after a latissimus dorsi transfer with 3 metal markers (placed at 2 cm, 4 cm and 6 cm from the tip of the tendon). The asterisks indicate the metallic anchor from a previous (failed) rotator-cuff repair. (A) Anteroposterior view. (B) Scapular profile view.

Fig. 3 (A, B) Postoperative rupture of a latissimus dorsi tendon transfer. Note the increased distance between the intact first marker (1st) and the displaced second and third (2nd and 3rd) metal markers. The asterisks indicate metallic anchors from a previous (failed) rotator-cuff repair. Note that the calcified lesion in the proximal part of the humerus is an enchondroma, not at all related to the procedure or the rotator-cuff tear. (A) Anteroposterior view. (B) Scapular profile view.

Fig. 4 (A-D) Latissimus dorsi tendon transfer elongated and reinforced with a tendinous allograft and performed through an isolated deltopectoral approach, as described by Miyazaki et al.⁶¹61 Miyazaki AN, Checchia CS, LopesWC, Fonseca Filho JM, do Val Sella G, Silva LA. Transferência tendínea do grande dorsal com enxerto tendíneo homólogo para as lesões irreparáveis do manguito rotador: técnica cirúrgica*. Rev Bras Ortop 2019;54(01):99–103 (A) Figure depicting tendon preparation before transfer. (B) Allograft preparation. (C) After passing the transfer behind the humerus. (D) Figure depicting final configuration of the latissimus dorsi tendon. Abbreviations: AG, allograft; TRI, triceps, LD, latissimus dorsi; RCT, rotator-Cuff Tear; LHB, long head of the biceps; TM, teres major; sub, subscapularis.

Fig. 5 (A-C) Drawings of the right shoulder. The line of pull from the lower trapezius (LT) more closely replicates the one from the infraspinatus (IS) than the one generated by the latissimus dorsi (LD). The line of pull from the LD closely replicates the line of pull from the subscapularis (SSCP). (A) Posterior view. (B) Anterior view. (C) Medial view.

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Current Options in Tendon Transfers for Irreparable Posterosuperior Rotator Cuff Tears

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[1] Address for correspondence Caio Santos Checchia, Grupo de Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesario Mota Junior, 112, Consolação, São Paulo, SP, 01221-020, Brazil (e-mail: caio.checchia@gmail.com).