This retrospective cohort compared latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears in two settings. Six patients had a primary reconstruction and 16 had salvage transfer after a failed prior cuff repair. The question: does the transfer perform as well in revision cases as it does primarily?
When you face an irreparable posterosuperior cuff tear (supraspinatus/infraspinatus loss with a positive Hornblower's sign), latissimus dorsi transfer restores external rotation and flexion by acting as both an active motor and a tenodesis.
The decision rule this paper hands you: assess the deltoid first. Deltoid detachment appeared only in failed prior repairs and drove Constant scores down to 43%, making it a relative contraindication. Check the Goutallier grade on MRI. Stage 3-4 fatty degeneration predicts poor recovery because that muscle will not regenerate no matter how good your repair.
Counsel every patient about rupture risk. It approaches 44% in salvage cases and paradoxically tends to strike the patients doing best, so activity modification is part of the postop plan. The practical message: salvage transfer still helps, but set expectations lower than for primary cases and select patients on deltoid integrity, tendon quality, and fatty degeneration.
This retrospective cohort compared latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears in two settings. Six patients had a primary reconstruction and 16 had salvage transfer after a failed prior cuff repair. The question: does the transfer perform as well in revision cases as it does primarily?
When you face an irreparable posterosuperior cuff tear (supraspinatus/infraspinatus loss with a positive Hornblower's sign), latissimus dorsi transfer restores external rotation and flexion by acting as both an active motor and a tenodesis.
The decision rule this paper hands you: assess the deltoid first. Deltoid detachment appeared only in failed prior repairs and drove Constant scores down to 43%, making it a relative contraindication. Check the Goutallier grade on MRI. Stage 3-4 fatty degeneration predicts poor recovery because that muscle will not regenerate no matter how good your repair.
Counsel every patient about rupture risk. It approaches 44% in salvage cases and paradoxically tends to strike the patients doing best, so activity modification is part of the postop plan. The practical message: salvage transfer still helps, but set expectations lower than for primary cases and select patients on deltoid integrity, tendon quality, and fatty degeneration.