Outcomes of Latissimus Dorsi Tendon Transfer for Posterosuperior Massive Rotator Cuff Tears and Failed Rotator Cuff Repair

Background: Although a recent systematic review found that latissimus dorsi tendon transfer (LDTT) granted comparable outcomes in shoulders with massive rotator cuff tears (mRCTs) versus those with failed rotator cuff repair (RCR), some studies found inferior outcomes after failed RCR.Purpose: To compare the clinical and functional outcomes, as well as complication rates, of patients who underwent LDTT for the treatment of mRCTs or failed RCR.Study Design: Case series; Level of evidence, 4.Methods: The authors retrieved the records of a consecutive series of 258 patients (n = 150, arthroscopically assisted; n = 108, all-arthroscopic) who underwent LDTT by the same senior surgeon between 2014 and 2021. A total of 136 patients underwent LDTT for irreparable posterosuperior mRCTs without previous RCR, whereas 122 underwent LDTT for failed RCR. All intra- and postoperative complications were noted, as well as whether patients required conversion to reverse shoulder arthroplasty. At a minimum follow-up of 24 months, an independent observer collected the range of motion and clinical scores including the Constant score, Subjective Shoulder Value (SSV), Simple Shoulder Test, Activities of Daily Living requiring Active External Rotation (ADLER) score, American Shoulder and Elbow Surgeons (ASES) score, and pain on visual analog scale (VAS).Results: At a minimum follow-up of 2 years after LDTT, no significant differences were noted between shoulders treated for mRCTs versus failed RCR in terms of rates of conversion to reverse shoulder arthroplasty (3% vs 3%, respectively), LDTT tear (8% vs 10%), or other complications (10% vs 11%). Shoulders treated for mRCTs had significantly better outcomes than those treated for failed RCR, in terms of ASES score (75.8 +/- 19.5 vs 65.6 +/- 24.2, respectively; P = .002), ADLER score (26.3 +/- 5.7 vs 24.8 +/- 6.4; P = .003), SSV (72.3 +/- 19.8 vs 63.6 +/- 24.0; P = .004), and pain on VAS (1.8 +/- 2.0 vs 2.7 +/- 2.7; P = .018) but not in terms of Constant score (69.2 +/- 13.4 vs 66.4 +/- 16.3, P = .520) and range of motion (P = .360-.700). Multivariable analysis confirmed that ASES score was worse for shoulders with previous RCR (beta, -9.90; 95% CI, -15.94 to 3.86; P = .001) and that Constant score was better for men (beta, 3.91; 95% CI, -0.06 to 7.88; P = .044).Conclusion: At a minimum follow-up of 24 months, LDTT granted better outcomes for the treatment of mRCTs than of failed RCR, notably in terms of activity and pain.