Comparing Anterior and Posterior Transfer of Latissimus Dorsi Tendon to Humeral Head in Patients with Massive and Irreparable Rotator Cuff Tear

Objectives: Latissimus dorsi tendon transfer is a treatment option in patients with irreparable rotator cuff tears. This study aimed to compare the effectiveness and safety of anterior and posterior transfer of latissimus dorsi tendon for anterosuperior or posterosuperior massive irr eparable rotator cuff tears.Methods: In this prospective clinical trial, ۲۷ patients with irreparable rotator cuff tears were treated with latissimus dorsi transfer. The transfers in ۱۴ and ۱۳ patients were from the anterior for anterosuperior cuff deficiency (group A) and from the posterior for posterosuperior cuff deficiency (group B), respectively. Pain, shoulder range of motion in forward elevation, abduction, external rotation, and functional scores were evaluated ۱۲ months after the surgery.Results: Two and one patients were excluded from the study due to not referring in time for follow-up and infection, respectively. Therefore, ۱۳ patients remained in group A and ۱۱ patients in group B. Visual analog scale scores decreased from ۶.۵ to ۳.۰ in group A (P=۰.۰۱۶) and from ۵.۹۰۹ to ۲.۸۱۸ in group B (P=۰.۰۲۸). The constant scores improved from ۴۱ to ۵۰.۲ (P=۰.۰۱۰) in group A and from ۳۰.۲ to ۴۲.۵ (P=۰.۰۰۱) in group B. There was a significant improvement in the abduction and forward elevation in both groups which was more significant in group B. The posterior transfer made significant improvement in external rotation; however, the anterior transfer did not change external rotation. No radial or axillary nerve injury was observed in any of the two groups.Conclusion: Latissimus dorsi transfer in patients with irreparable rotator cuff tears has a significant effect on recovery. It improves shoulder function and range of motion and reduces pain. Improvement of shoulder elevation and abduction is more significant in posterior transfer. The anterior transfer is as safe as the posterior transfer for nerve injury. Level of evidence: II

Keywords:

latissimus dorsi , Rotator cuff tear , shoulder , tendon transfer