Management of massive irreparable rotator cuff tears: the role of tendon transfer.

The inability to repair a rotator cuff tear is not uncommon, and in practices devoted to the management of shoulder injuries up to 30% of rotator cuff tears may be irreparable. The anterior and posterior components of the rotator cuff are the most important deficient areas. In the case of an irreparable subscapularis tendon tear, pain relief and stability appear to be reliably achieved by a split pectoralis major transfer; however, functional improvement is less certain because the biomechanics associated with this tendon transfer do not appear to be optimal. In the case of an irreparable posterosuperior rotator cuff tear, a latissimus dorsi tendon transfer reliably restores flexion and relieves pain; however, its use after failure of prior rotator cuff surgery makes the outcome less predictable. Both anterior and posterior reconstructions with tendon transfer require precise surgical technique and patient compliance with postoperative rehabilitation.