# The effectiveness of anterior latissimus dorsi and teres major tendon transfers from subscapularis and anterosuperior cuff tears to reverse shoulder arthroplasty: a narrative review

## TL;DR

This review examines how tendon transfers can help treat complex shoulder injuries and improve outcomes in patients with rotator cuff tears and limited treatment options.

## Contribution

The paper reviews the effectiveness of latissimus dorsi and teres major tendon transfers in treating complex shoulder conditions, particularly in reverse shoulder arthroplasty.

## Key findings

- Latissimus dorsi transfer effectively replicates subscapularis function in irreparable tears.
- Combined latissimus dorsi-teres major transfer improves joint stabilization in anterosuperior cuff tears.
- LDTM transfer enhances shoulder function in reverse shoulder arthroplasty for massive cuff tears.

## Abstract

Managing of rotator cuff tears, particularly those involving the subscapularis (SSC), anterosuperior cuff, and massive cuff tears with SSC insufficiency, presents significant clinical challenges. Tendon transfers, specifically latissimus dorsi (LD) and combined latissimus dorsi-teres major (LDTM), have emerged as effective surgical options across these scenarios. This review explores the utility and outcomes of these tendon transfers in addressing irreparable SSC tears, anterosuperior cuff tears, as well as massive cuff tears with SSC insufficiency in the context of reverse shoulder arthroplasty (rTSA). This review consolidates existing research on the biomechanics, clinical outcomes, and surgical techniques of LD and LDTM transfers, particularly for SSC tears, anterosuperior cuff tears, and in the context of rTSA for massive cuff tears with SSC insufficiency. The focus was on the effectiveness of these transfers in restoring function and improving clinical outcomes. For irreparable SSC tears, LD transfer showed superior alignment with the transfer principles, effectively replicating the SSC's line of pull, reporting favorable clinical outcomes in short- and long-term follow-ups. In anterosuperior cuff tears, the combined LDTM transfer demonstrated to provide improved joint stabilization by scapulohumeral kinematics with TM and powerful combined 2 tendon transfer, particularly when isolated LD transfer is insufficient. In the context of rTSA for massive cuff tears with SSC insufficiency, the concomitant LDTM transfer demonstrated the capacity to significantly enhance shoulder function, particularly addressing specific deficits in internal rotation compared to rTSA alone. This review underscores the encouraging potential of LD and combined LDTM tendon transfers for addressing complex shoulder pathology, especially irreparable SSC and anterosuperior rotator cuff tears, as well as internal rotation deficits following rTSA in patients with massive cuff tears with SSC insufficiency. While current evidence is promising, further well-designed comparative studies are essential to corroborate these results and optimize their application in complex cases where treatment options are restricted.