Single versus dual tendon transfer for global irreparable rotator cuff tears

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Research
• Biomechanical Engineering

Background:

• Global irreparable rotator cuff tears (GIRCTs) present a significant challenge in orthopedic surgery.
• Tendon transfer procedures, including single (anterior latissimus dorsi and teres major [aLDTM]) and dual (aLDTM with arthroscopy-assisted lower trapezius tendon transfer) techniques, are utilized for treatment.
• Outcomes of single versus dual tendon transfer for GIRCTs require detailed comparative analysis.

Purpose of the Study:

• To compare the clinical outcomes of single versus dual tendon transfer for patients with global irreparable rotator cuff tears (GIRCTs).
• To evaluate the efficacy of dual tendon transfer in improving functional outcomes and reversing signs of pseudoparalysis.

Main Methods:

• A retrospective comparative study involving 48 patients in the single transfer group and 25 in the dual transfer group.
• Primary outcome measured by the Activities of Daily Living Requiring External Rotation (ADLER) score.
• Secondary outcomes included visual analog scale (VAS) scores, patient-reported outcome measurements (PROMs), active range of motion (aROM), reversal of pseudoparalysis and external rotation (ER) lag sign, and muscle strength.

Main Results:

• Both single and dual transfer groups demonstrated significant improvements in VAS, PROMs, aROM, and muscle strength.
• The dual transfer group showed significantly higher ADLER scores, aROM of ER, FE strength, and ER strength compared to the single transfer group.
• All patients in the dual transfer group experienced improvement in pseudoparalysis and ER lag sign, unlike in the single transfer group.

Conclusions:

• Both single and dual tendon transfers are effective for GIRCTs.
• Dual tendon transfer offers superior outcomes, particularly for patients with preoperative pseudoparalysis or ER lag sign.
• The findings support dual transfer as a potentially more appropriate surgical option in specific patient populations with GIRCTs.