Tendon transfer for massive rotator cuff tears: A narrative review

Tendon transfer is a widely used surgical approach for managing irreparable rotator cuff tears (IRCTs) and nerve-related shoulder dysfunctions when direct repair is not feasible. By restoring shoulder stability and function, tendon transfers compensate for lost muscle activity through biomechanically strategic reattachments. Common procedures include latissimus dorsi (LD) transfer, with or without teres major (TM), and lower trapezius (LT) transfer for posterior-superior IRCTs. For anterior-superior IRCTs, LD transfer with or without TM and pectoralis major (PM) transfer are commonly performed. Middle trapezius (MT) transfer has emerged as an option for irreparable supraspinatus tears. In complex cases, dual tendon transfers combining multiple tendons have been introduced to optimize shoulder biomechanics, particularly in patients with extensive deficits. Despite their benefits, tendon transfers pose significant challenges. Complications include neurovascular injury, improper tensioning leading to altered biomechanics, infection, tendon rupture, and graft failure. Careful patient selection, precise surgical execution, and structured postoperative rehabilitation are critical for minimizing complications and achieving favorable outcomes. This review explores the fundamental concepts of tendon transfer, focusing on its indications, biomechanical considerations, clinical outcomes, and associated complications. A comprehensive understanding of these principles is essential for optimizing functional recovery and ensuring long-term success in shoulder reconstruction.