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Tendon transfers for rotator cuff pathologies

Wagner, Eric R. MDa; Elhassan, Bassem T. MDb

doi: 10.1097/BCO.0000000000000757
Special Focus: Upper Extremity Rotation

Irreparable rotator cuff tears remain one of the most challenging pathologies faced by shoulder surgeons. In both irreparable anterior (subscapularis) and posterosuperior (supraspinatus and infraspinatus) tears, patients experience marked shoulder dysfunction and pain. In this article, we review the surgical considerations for treating patients with these tears, as well as the tendon transfer options. Irreparable rotator cuff tears are associated with advanced fatty infiltration, tendon retraction, and loss of tendon length. Although there are multiple reconstructive options, most are limited to small series with short-term follow-up. Tendon transfers have emerged as very promising reconstructive options for these patients. When considering the ideal tendon transfer, it is critical to consider the four-tendon transfer principles, as well as the ability of patients to retrain the new transfer to perform a different function. The historical option for posterosuperior tears involved a latissimus dorsi transfer, while the lower trapezius transfer emerged in recent years. The historical transfer for irreparable subscapularis tears was the pectoralis major transfer, while the latissimus dorsi emerged in recent years. Further comparative trials with large patient numbers and longer follow-up are needed to better understand the indications for each of these transfers to treat these difficult pathologies.

aEmory University, Atlanta, GA

bMayo Clinic, Rochester, MN

Financial Disclosure: The authors report no conflicts of interest.

Correspondence to Bassem T. Elhassan, MD, Mayo Clinic Minnesota, Orthopedics, 200 First Street SW, Rochester, MN 55905 Tel: +507-255-5123; fax: +617-724-9904; e-mail:

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