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<p>The latissimus dorsi transfer (LDT) and lower trapezius transfer (LTT) have proven to be suitable joint-preserving treatment options for restoring the active external rotation capability and the balance of the muscular force pairs in cases of posterosuperior rotator cuff insufficiency. These procedures can be performed in active patients under 65&#xa0;years of age with isolated pseudoparalysis of external rotation and without any relevant defect arthropathy (Hamada stage ≤ 2). Although LDT is the most extensively studied tendon transfer with satisfactory long-term outcomes, it is a&#xa0;surgically demanding procedure with a&#xa0;flat learning curve and requires above-average patient compliance. Anatomically, the LTT is better positioned to compensate for the deficient posterosuperior rotator cuff, as the resultant force vector is almost parallel to that of the native infraspinatus. The short-term to mid-term clinical outcomes following LTT are convincing, including significant improvements in shoulder range of motion, functional scores and pain relief. Compared to the LDT arthroscopically assisted LTT also demonstrates significantly better functional scores, superior active external rotation and notably less progression of osteoarthritis after a&#xa0;minimum follow-up of 2 years. Recently, the middle trapezius transfer (MTT) has been proposed for isolated irreparable supraspinatus tendon tears. The rationale lies in the anatomically nearly parallel pulling direction of the middle trapezius to the supraspinatus tendon, which was confirmed in an anatomical feasibility study; however, due to the limited clinical experience with respect to the results to be expected, the MTT remains in the experimental phase.</p>

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Muskel-Sehnen-Transfer-Optionen bei irreparabler posterosuperiorer Rotatorenmanschettenruptur

  • 期刊论文

  • 发表日期：

    2025年4月10日

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  • Lukas N. Münch,
  • Lucca Lacheta,
  • Bastian Scheiderer,
  • Sebastian Siebenlist

摘要

The latissimus dorsi transfer (LDT) and lower trapezius transfer (LTT) have proven to be suitable joint-preserving treatment options for restoring the active external rotation capability and the balance of the muscular force pairs in cases of posterosuperior rotator cuff insufficiency. These procedures can be performed in active patients under 65 years of age with isolated pseudoparalysis of external rotation and without any relevant defect arthropathy (Hamada stage ≤ 2). Although LDT is the most extensively studied tendon transfer with satisfactory long-term outcomes, it is a surgically demanding procedure with a flat learning curve and requires above-average patient compliance. Anatomically, the LTT is better positioned to compensate for the deficient posterosuperior rotator cuff, as the resultant force vector is almost parallel to that of the native infraspinatus. The short-term to mid-term clinical outcomes following LTT are convincing, including significant improvements in shoulder range of motion, functional scores and pain relief. Compared to the LDT arthroscopically assisted LTT also demonstrates significantly better functional scores, superior active external rotation and notably less progression of osteoarthritis after a minimum follow-up of 2 years. Recently, the middle trapezius transfer (MTT) has been proposed for isolated irreparable supraspinatus tendon tears. The rationale lies in the anatomically nearly parallel pulling direction of the middle trapezius to the supraspinatus tendon, which was confirmed in an anatomical feasibility study; however, due to the limited clinical experience with respect to the results to be expected, the MTT remains in the experimental phase.