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Current Options in Tendon Transfers for Irreparable Rotator Cuff Tears

Checchia, Caio, MD1; Domos, Peter, MD, FRCS2; Grimberg, Jean, MD3; Kany, Jean, MD4

doi: 10.2106/JBJS.RVW.18.00044
Review Articles

  • * 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.

1Santa Casa School of Medicine, São Paulo, Brazil

2The Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom

3Institut de recherche en chirurgie orthopédique sportive, Clinique Remusat, Paris, France

4Toulouse Shoulder Unit, Clinique de l’Union, Saint Jean, France

E-mail address for C. Checchia:

Investigation performed at the Santa Casa School of Medicine, São Paulo, Brazil

Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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