Lower trapezius and latissimus dorsi transfer relieve teres minor activity into the physiological range in Collin D irreparable posterosuperior massive rotator cuff tears: a biomechanical analysis

Background: Tendon transfers are established techniques to regain external rotation mobility in patients with an irreparable, posterosuperior massive rotator cuff tear (MRCT). Posterosuperior MRCT with intact teres minor (type D MRCT) can lead to excessive teres minor loading to maintain external rotation. We hypothesize that tendon transfers are effective in relieving teres minor loading in type D MRCTs. Our aim was to biomechanically assess muscle synergism with latissimus dorsi (LD transfer) and lower trapezius (LT transfer) tendon transfer during external rotation at different abduction heights. Methods: Using musculoskeletal modeling, we analyzed and compared the moment arm, muscle torque, and muscle activity between a healthy and type D MRCT pathologic model with and without the LD- or LT transfer at infraspinatus and teres minor insertion sites. Output measures were analyzed during external rotation at different abduction angles and 10-50 N resistance against external rotation. We assessed its impact on teres minor loading in a type D MRCT. Morphologic variations were parameterized using the critical shoulder angle and the acromiohumeral distance to address variations among patients. Results: Both transfer types reduced teres minor torque and activity significantly, reaching physiological state at 40 N external resistance (P < .001), with insertion to infraspinatus site being more effective than teres minor site (P < .001). External rotation moment arms of LD transfer were larger than LT transfer at 90 degrees abduction (25.1 +/- 0.8 mm vs. 21.2 +/- 0.6 mm, P < .001) and vice versa at 0 degrees abduction (17.4 +/- 0.5 mm vs. 24.0 +/- 0.2 mm, P < .001). Although the healthy infraspinatus was the main external rotator in all abduction angles (50%-70% torque), a type D MRCT resulted in a 70%-90% increase of teres minor torque and an up to 7-fold increase in its activity leading to excessive loadings beyond 10 N resistance against external rotation. Varying the critical shoulder angle and the acromiohumeral distance led to minor variations in muscle moment arm and muscle activity. Conclusion: We identified biomechanical efficacy of both tendon transfers in type D MRCT regarding teres minor load relief and superior performance of the transfers at the infraspinatus insertion site. (c) 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights are reserved, including those for text and data mining, AI training, and similar technologies.