This study looked at what predicts success after latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Fourteen patients were assessed at a minimum of 24 months with the PENN shoulder score, strength testing, MRI, and EMG. The goal was to link clinical outcome to patient factors and to the anatomic and electrical function of the transfer.
Patient selection, not surgical technique, drives outcome here. The transfer adds strength to a shoulder that already elevates to shoulder level, but it cannot manufacture motion in a pseudoparalytic shoulder.
When you see an irreparable posterosuperior tear with active elevation below chest level and generalized weakness, especially in an older or deconditioned patient, this operation can leave them worse off. Two of five severely weak patients here declined after surgery.
The MRI and EMG data are reassuring in a specific way: the tendon heals and stays innervated, so a poor result is about baseline muscle capacity, not a technical failure. Note that much of the benefit likely comes from a tenodesis effect rather than reliable in-phase muscle firing, which only one patient showed during elevation.
Confirm an intact subscapularis and a functioning deltoid before offering this, and set expectations accordingly.
This study looked at what predicts success after latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Fourteen patients were assessed at a minimum of 24 months with the PENN shoulder score, strength testing, MRI, and EMG. The goal was to link clinical outcome to patient factors and to the anatomic and electrical function of the transfer.
Patient selection, not surgical technique, drives outcome here. The transfer adds strength to a shoulder that already elevates to shoulder level, but it cannot manufacture motion in a pseudoparalytic shoulder.
When you see an irreparable posterosuperior tear with active elevation below chest level and generalized weakness, especially in an older or deconditioned patient, this operation can leave them worse off. Two of five severely weak patients here declined after surgery.
The MRI and EMG data are reassuring in a specific way: the tendon heals and stays innervated, so a poor result is about baseline muscle capacity, not a technical failure. Note that much of the benefit likely comes from a tenodesis effect rather than reliable in-phase muscle firing, which only one patient showed during elevation.
Confirm an intact subscapularis and a functioning deltoid before offering this, and set expectations accordingly.