# Tendon transfers in the setting of shoulder arthroplasty

## TL;DR

Tendon transfers combined with reverse shoulder surgery improve function in patients with shoulder arthritis and torn rotator cuffs.

## Contribution

The paper reviews recent surgical techniques for tendon transfers in reverse shoulder arthroplasty.

## Key findings

- Latissimus dorsi transfers show better outcomes for subscapularis insufficiency than pectoralis major transfers.
- Lower trapezius transfers outperform latissimus transfers for posterosuperior rotator cuff deficiency.
- Pedicled pectoralis major transfers can address deltoid deficiency in shoulder arthroplasty.

## Abstract

Tendon transfers in conjunction with reverse total shoulder arthroplasty can significantly improve functional outcomes in patients with glenohumeral arthritis and irreparable rotator cuff deficiency. There have been multiple promising new techniques described within the last 20 years that shoulder surgeons should become familiar with.

The authors reviewed the literature on tendon transfers in the setting of reverse total shoulder arthroplasty. Procedures to restore various shoulder functions were described including surgical anatomy, techniques, pearls and pitfalls, and photos.

Subscapularis insufficiency can be reconstructed with a pectoralis major transfer or latissimus dorsi transfer, with the latter having better clinical outcomes and a more anatomic line of pull. Posterosuperior rotator cuff deficiency can be reconstructed with a latissimus transfer (L’Episcopo transfer) or lower trapezius transfer, with the latter proving superior in biomechanical and short-term studies. Deltoid deficiency can be reconstructed with a pedicled upper pectoralis major transfer. Massive proximal humerus bone loss can be reconstructed with an allograft-prosthetic composite, and any of the aforementioned transfers can be utilized in this setting as well.

Tendon transfers in conjunction with reverse shoulder arthroplasty can significantly improve functional outcomes in patients with glenohumeral arthritis and irreparable rotator cuff deficiency. There have been multiple promising new techniques described within the last 20 years that shoulder surgeons should become familiar with.