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Objective <p>Anterosuperior irreparable rotator cuff tears (ASIRCTs), involving the supraspinatus and subscapularis, cause severe dysfunction. Combined anterior latissimus dorsi and teres major (aLDTM) tendon transfer restores transverse plane force coupling; however, superior stability may not be maintained when the preoperative acromiohumeral distance (AHD) is narrow. This study compared aLDTM tendon transfer alone versus aLDTM tendon transfer with arthroscopy-assisted middle trapezius transfer (aMTT).</p> Methods <p>We retrospectively reviewed 49 patients with ASIRCTs and preoperative AHD ≤ 6&#xa0;mm who underwent aLDTM tendon transfer between 2020 and 2023. Group A (<i>n</i> = 28) received aLDTM tendon transfer alone, and Group M (<i>n</i> = 21) received aLDTM tendon transfer with aMTT. Clinical outcomes at postoperatively 2 years included shoulder pain, patient-reported outcome measures (PROMs), active range of motion (aROM) and aROM strength. Radiologic outcomes included AHD, Hamada grade and transferred tendon integrity. The differences between the two groups exceeding the minimum clinically important difference (MCID) were considered clinically relevant.</p> Results <p>Both groups showed significant improvements in shoulder pain, PROMs, aROM, and aROM strength. However, Constant scores (66.0 ± 11.8 vs 75.4 ± 6.9, <i>p</i> = 0.011), forward elevation (FE) (144.6 ± 24.9˚ vs 161.0 ± 9.4˚, <i>p</i> = 0.010), abduction (118.9 ± 26.5˚ vs 137.1 ± 16.2˚, <i>p</i> = 0.014), FE strength (24.4 ± 4.5N vs 28.4 ± 3.9N, <i>p</i> = 0.006) and ABD strength (22.6 ± 6.3N vs 26.9 ± 2.3N, <i>p</i> = 0.009) of group M were significantly higher than that of group A. Moreover, all surpassing MCID thresholds. Postoperative AHD was also greater in Group M (6.9 ± 1.1&#xa0;mm vs 10.0 ± 3.4&#xa0;mm, <i>p</i> &lt; 0.001). Operative time (47.9 ± 4.0&#xa0;min vs 96.8 ± 5.4&#xa0;min, <i>p</i> &lt; 0.001) and hospital day (7.9 ± 1.2&#xa0;days vs 8.7 ± 0.9days, <i>p</i> = 0.008) were significantly shorter in Group A.</p> Conclusions <p>In ASIRCTs with preoperative AHD ≤ 6&#xa0;mm, both procedures improved function and radiology, but the addition of aMTT provided superior recovery of AHD, overhead motion, and strength. Augmenting an aLDTM tendon transfer with an aMTT may represent an effective strategy for optimizing outcomes in this challenging population.</p> Level of evidence <p>Level III, retrospective comparative study.</p>

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Clinical Outcome of Adding Middle Trapezius Transfer to Anterior Latissimus Dorsi and Teres Major Transfer in Anterosuperior Irreparable Rotator Cuff Tears with Narrow Acromiohumeral Distance: A Comparative Study

  • 期刊论文

  • 发表日期：

    2026年3月11日

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  • Chang Hee Baek,
  • Chaemoon Lim,
  • Jung Gon Kim,
  • Bo Taek Kim,
  • Seung Jin Kim

摘要

Objective

Anterosuperior irreparable rotator cuff tears (ASIRCTs), involving the supraspinatus and subscapularis, cause severe dysfunction. Combined anterior latissimus dorsi and teres major (aLDTM) tendon transfer restores transverse plane force coupling; however, superior stability may not be maintained when the preoperative acromiohumeral distance (AHD) is narrow. This study compared aLDTM tendon transfer alone versus aLDTM tendon transfer with arthroscopy-assisted middle trapezius transfer (aMTT).

Methods

We retrospectively reviewed 49 patients with ASIRCTs and preoperative AHD ≤ 6 mm who underwent aLDTM tendon transfer between 2020 and 2023. Group A (n = 28) received aLDTM tendon transfer alone, and Group M (n = 21) received aLDTM tendon transfer with aMTT. Clinical outcomes at postoperatively 2 years included shoulder pain, patient-reported outcome measures (PROMs), active range of motion (aROM) and aROM strength. Radiologic outcomes included AHD, Hamada grade and transferred tendon integrity. The differences between the two groups exceeding the minimum clinically important difference (MCID) were considered clinically relevant.

Results

Both groups showed significant improvements in shoulder pain, PROMs, aROM, and aROM strength. However, Constant scores (66.0 ± 11.8 vs 75.4 ± 6.9, p = 0.011), forward elevation (FE) (144.6 ± 24.9˚ vs 161.0 ± 9.4˚, p = 0.010), abduction (118.9 ± 26.5˚ vs 137.1 ± 16.2˚, p = 0.014), FE strength (24.4 ± 4.5N vs 28.4 ± 3.9N, p = 0.006) and ABD strength (22.6 ± 6.3N vs 26.9 ± 2.3N, p = 0.009) of group M were significantly higher than that of group A. Moreover, all surpassing MCID thresholds. Postoperative AHD was also greater in Group M (6.9 ± 1.1 mm vs 10.0 ± 3.4 mm, p < 0.001). Operative time (47.9 ± 4.0 min vs 96.8 ± 5.4 min, p < 0.001) and hospital day (7.9 ± 1.2 days vs 8.7 ± 0.9days, p = 0.008) were significantly shorter in Group A.

Conclusions

In ASIRCTs with preoperative AHD ≤ 6 mm, both procedures improved function and radiology, but the addition of aMTT provided superior recovery of AHD, overhead motion, and strength. Augmenting an aLDTM tendon transfer with an aMTT may represent an effective strategy for optimizing outcomes in this challenging population.

Level of evidence

Level III, retrospective comparative study.