Shoulder Tendon Transfers for Rotator Cuff Deficiency
Authors: C Talbot, A Watts, J Grimberg, L Funk
References: Shoulder And Elbow Journal, 2012
There are a number of reports in the literature to support the use of Latissimus Dorsi Tendon Transfer in carefully selected patients with massive irreparable postero-superior rotator cuff tears alone or in combination with reverse geometry shoulder arthroplasty.
A significant number of different techniques of Latissimus Dorsi Tendon Transfer exist in the literature and make interpretation of the results somewhat difficult. The optimum insertion site appears to have been identified in computational and biomechanical models, though correlation with clinical outcome is needed through further clinical trials. Similarly the tendon re-attachment methods are numerous with theoretical advantages cited by their proponents; these “advantages” however are not fully evaluated in the current body of literature. It is suggested that surgeons should use a technique they are familiar with and that they audit their own experience to ensure tendon re-attachment is successful.
The literature also consistently supports less favourable outcomes in revision or salvage surgery. This may be seen as disappointing as surgeons may attempt complete or partial rotator cuff repair in patients with massive tears as a primary procedure, often with good results. However, any further surgery in the form of tendon transfer surgery is not as likely to produce such a good result as primary transfer; this should be considered in counselling patients for Latissimus Dorsi Tendon Transfer surgery.