Current Options in Tendon Transfers for Irreparable Rotator Cuff Tears

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For posterosuperior tears, even though these are not absolute contraindications, the following preoperative variables have been found to significantly correlate with poorer outcomes when performing a latissimus dorsi tendon transfer (or possibly even other tendon transfers, but very few data are available concerning these tears): previous shoulder surgical procedure, atrophy and fatty infiltration (Goutallier stage of ≥3) of the teres minor muscle, subscapularis insufficiency (positive lift-off test), pseudoparetic shoulders (defined as those with massive rotator cuff tears and with active elevation of <90°), and passive forward elevation of ≤80°.For isolated subscapularis failure, pectoralis major tendon transfers have disappointing results, and some data on combined latissimus dorsi and teres major transfers have shown clinical improvement at 2 years.The following 5 principles of tendon transfers should be respected whenever possible: (1) accurate positioning of the transferred tendon reimplantation site, (2) physiological tensioning of the transferred muscle-tendon unit, (3) strong osseous fixation of the reimplanted tendon, (4) minimally invasive surgery to reduce muscle scarring (so as not to hinder excursion of the transfer), and (5) a synergistic transfer.

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