AANA Lab Course 906- Técnicas Avanzadas de Cirugía de Hombro-Manguito rotador no reparable_ Transferencias tendinosis-Joaquin Sánchez-Sotelo, MD, PhD

Manguito rotador no reparable_ Transferencias tendinosis-Joaquin Sánchez-Sotelo, MD, PhD

Pdf Summary

This document by Dr. Joaquin Sanchez-Sotelo from Mayo Clinic reviews tendon transfer techniques for treating irreparable rotator cuff tears, focusing on shoulder function restoration.<br /><br />Irreparable rotator cuff tears, often massive, cannot be repaired surgically or repairs fail to improve pain or function. Treatment options include conservative management, reverse shoulder arthroplasty, superior capsule reconstruction, subacromial balloon, and tendon transfers.<br /><br />Tendon transfer principles emphasize the line of action, excursion, and force to optimize biomechanical effectiveness. Classic transfers address posterosuperior and anterosuperior cuff tears. The latissimus dorsi (LD) transfer is commonly used for posterosuperior tears but requires intact subscapularis and absence of pseudoparalysis; results are variable. The pectoralis major transfer is used for anterosuperior tears with inconsistent outcomes depending on tear pattern and prosthetic stability. Both transfers have limitations related to their mechanical vectors and strength.<br /><br />Newer alternatives include lower trapezius tendon transfer, particularly arthroscopically assisted with Achilles allograft augmentation. This transfer offers advantages in line of action, synergistic activity, ease of technique, and avoids scapulohumeral dysfunction. However, it is an indirect transfer and may carry a risk of scapular dyskinesia.<br /><br />Anterior latissimus dorsi transfer is another option with mechanical advantages: it acts as a humeral depressor, resists anterior translation, and provides adequate internal rotation strength.<br /><br />Current recommendations suggest tailoring treatment to tear type and joint status: conservative treatment or tendon transfers (like anterior latissimus dorsi or lower trapezius) for irreparable tears without cuff arthropathy, and reverse arthroplasty with or without transfers for those with cuff arthropathy. Transfers aim to restore motion and strength, particularly external rotation.<br /><br />In summary, tendon transfers represent a vital option for irreparable rotator cuff tears, with emerging preferences toward lower trapezius transfers combined with biological augmentation for improved functional outcomes.

Keywords

irreparable rotator cuff tears

tendon transfer techniques

shoulder function restoration

latissimus dorsi transfer

pectoralis major transfer

lower trapezius tendon transfer

Achilles allograft augmentation

reverse shoulder arthroplasty

scapular dyskinesia

external rotation strength