Dual Transfer, Latissimus Dorsi Transfer Combined with Middle Trapezius Tendon Transfer for Posterosuperior Irreparable Rotator Cuff Tears Without Arthritic Change.

Objective: This study aimed to evaluate the clinical and radiologic outcomes of arthroscopy-assisted Latissimus dorsi tendon transfer (LDT) combined with middle trapezius tendon transfer (MTT) in posterosuperior irreparable rotator cuff tears (PSIRCTs) patients without arthritic changes. Methods: This retrospective case series reviewed the 15 PSIRCTs patients who underwent arthroscopy-assisted LDT combined with MTT from January to December 2020. Clinical outcomes were evaluated using the visual analog scale (VAS) score, patient-reported outcome measurements (PROMs) including Constant-Murley, American Shoulder and Elbow Surgeons (ASES), University of California Los Angeles (UCLA), and single assessment numeric evaluation (SANE) shoulder score, active range of motion (aROM) and aROM strength. The progression of arthritic changes was assessed using acromiohumeral distance (AHD) and Hamada grade. The integrity of transferred tendon was evaluated using magnetic resonance imaging. Results: Significant improvements were observed in VAS score and PROMs including Constant-Murley, ASES, UCLA, and SANE shoulder score between preoperative and postoperative periods. Significant improvement was also noted in aROM including forward elevation, abduction, and external rotation. Moreover, the strength of forward elevation, abduction strength, and external rotation were significantly improved postoperatively. There was no significant change between the preoperative and postoperative AHD and Hamada grade. However, osteoarthritic changes were found in two patients. One patient was presented with latissimus dorsi tendon retear, and one patient had middle trapezius tendon retear. Conclusion: As a dual transfer, arthroscopy-assisted LDT combined with MTT could be a good treatment option in PSIRCTs patients without arthritic changes due to the complete restoration of glenohumeral joint kinematics. Level of Evidence: Level IV.