Mid-term outcomes of combined anterior latissimus dorsi and teres major tendon transfer for irreparable anterosuperior rotator cuff tears

Aims: Combined anterior latissimus dorsi and teres major tendon transfer has been introduced as a joint-preserving surgical option for patients with an irreparable anterosuperior rotator cuff tear involving both the subscapularis and supraspinatus tendons. This procedure includes synergistic biomechanics to improve the strength of internal rotation and the stability of the shoulder. The aim of this study was to assess the mid-term clinical and radiological outcomes of the procedure in patients with an irreparable rotator cuff tear. The short-term outcomes at a mean follow-up of 38.1 months (24 to 63) in some of these patients have previously been reported. Methods: A retrospective review was performed on patients with irreparable anterior rotator cuff tears who underwent a combined latissimus dorsi and pectoralis major tendon transfer between April 2015 and January 2019. Inclusion criteria involved patients with irreparable subscapularis and supraspinatus tears (Goutallier grade ≥ 3), preserved or reparable infraspinatus and teres minor tendons, no pseudoparalysis and a Hamada grade of cuff tear arthropathy of ≤ II. A total of 31 patients, with a mean age of 66.1 years (57 to 81), met the inclusion criteria and were followed up for a minimum of five years. Clinical evaluation included standardized outcome scores, the strength of internal and external rotation, and the active range of motion (ROM). Radiological assessment included the acromiohumeral distance (AHD), the progression of Hamada grade, and static anterior subluxation. Results: At a mean follow-up of 74.7 months (66 to 92), significant improvements were noted in clinical scores, internal rotation and active ROM (mean increase from 3.9 to 6.3; p < 0.001), and strength of internal rotation (p < 0.001), whereas the range and strength of external rotation remained unchanged. There was no significant progression in AHD or Hamada grade, and in 15 patients with anterior subluxation preoperatively, this resolved unremarkably postoperatively. Re-tears at the musculotendinous junction occurred in four patients (12.9%). One patient required conversion to reverse shoulder arthroplasty, 6.2 years postoperatively. Conclusion: A combined latissimus dorsi and pectoralis major tendon transfer yielded favourable clinical and radiological outcomes at a mid-term follow-up of nearly six years in patients with an irreparable anterosuperior rotator cuff tear, with sustained functional improvement and radiological stability. These findings support its role as a reliable joint-preserving surgical option, particularly for relatively young and active patients, although further larger studies with longer follow-up are needed to confirm these findings.