Summary

Clinical Outcomes of Fully Arthroscopic Latissimus Dorsi Tendon Transfer for Irreparable Subscapularis Tendon Tears

Abstract

Background

For the treatment of irreparable subscapularis (SSC) tear, latissimus dorsi tendon transfer (LDTT) has been recommended. Technological advancements now enable LDTT to be fully arthroscopic, but its clinical outcomes have not yet been confirmed.

Purpose

To investigate the clinical outcomes and complication rates of fully arthroscopic LDTT for irreparable SSC tears.

Study Design: Retrospective study; Level of evidence, 4.

Methods

The study included 8 patients who had undergone fully arthroscopic LDTT from June 2022 to April 2024. Procedure duration and all complications were recorded, as well as clinical scores and range of motion at latest follow-up. Visual analog scale (VAS) for pain, range of motion (ROM), functional outcome measures including American Shoulder and Elbow Surgeons (ASES) form, University of California Los Angeles score (UCLA) and Simple shoulder test (SST) were assessed and compared pre and post-operatively. The strength of internal rotation was evaluated using bear-hug test and internal rotation resistance test at 90° abduction and external rotation (IRRT90°) and qualified by hand-held dynamometer (Model 01165A).

Results

The procedure time was about 120-200 minutes for full-arthroscopic LDTT, and no neurovascular injury or infection complications were found. At the time of the latest follow-up, the mean VAS pain (pre-operation 6.4 ± 1.9 ; post-opreration1.4 ± 1.3 ), SST (pre-operation 5.1 ± 2.2 ; post-operation 9.1 ± 1.9 ), ASES (pre-operation 46.1 ± 10.6; post-operation 82.4 ± 7.3 ), and UCLA (pre-operation15.6 ± 2.7; post-operation 28.1 ± 2.6 ) shoulder scores improved significantly. Active forward elevation (pre-operation 123.8 ± 30.9; post-operation 146.9 ± 18.4), external rotation with the arm at the side (pre-operation 35.2 ± 19.1；post-operation 46.4 ± 9.4 ), and internal rotation (pre-operation10.1 ± 4.3；post-operation 8.5 ± 2.4) also improved significantly compared with preoperative values (p < 0.001). Internal rotation strength was improved dramatically (p < 0.001) postoperatively.

Conclusion

LDTT improved the overall clinical outcomes of patients with irreparable SSC tear in terms of shoulder ROM, functional improvement, and strength of internal rotation. Our findings indicate that all-arthroscopic LDTT may be the preferred treatment option for irreparable SSC tear in relatively active and young patients.

Keywords: latissimus dorsi tendon transfer; Subscapularis tear; all-arthroscopic