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Updated: Jun 5, 2026
Arthroscopic Management of Massive Irreparable Rotator Cuff Tears: Whole Rotator Cable Reconstruction Using Proximal Biceps Tendon Autograft
Published on: June 6, 2025
Management of massive rotator cuff tears involving irreparable subscapularis tear by arthroscopically assisted
Mohamad K Moussa1, Issam Khaled2, Ahmad Nassar2
1Institut de la Main, Shoulder Department, Clinique Bizet, Paris, France; Group Hospitalier Sélestat Obernai, Sélestat, France.
Background:
This study aims to evaluate the outcomes of arthroscopically assisted latissimus dorsi (LD) transfer for massive rotator cuff tears involving irreparable subscapularis tendon tears.
Methods:
This case series study was conducted at a specialized Shoulder Unit in Paris from June 2014 to January 2023 to evaluate outcomes of LD transfer for irreparable subscapularis tendon tears. The primary outcome was the Constant score; secondary outcomes included visual analog scale, subjective shoulder value, and satisfaction levels. A subgroup analysis was performed to compare postoperative outcomes between patients with reparable versus irreparable supraspinatus tendons. Additionally, all complications were recorded.
Results:
Twenty-one patients, predominantly male (90.5%) with a mean age of 58.6 years (SD 8.2), were included. Most had the right shoulder affected (85.7%), with a mean follow-up of 15.3 months (SD 11.9). The mean Constant score significantly increased from 37.4 ± 9.7 preoperatively to 70.5 ± 11 postoperatively (gain of 31.5 ± 20, P < .001). The mean visual analog scale score decreased from 4.4 ± 1.9 to 1.5 ± 1.5 (reduction of -2.7 ± 2.6, P < .001). The mean subjective shoulder value improved from 49.5 ± 14.3 to 76 ± 11.4 (gain of 25.2 ± 25, P < .001). Satisfaction levels were high, with 16 patients very satisfied, 4 satisfied, and 1 disappointed. Subgroup analysis showed a trend toward better outcomes in the reparable supraspinatus group, although these differences were not statistically significant. Three complications (14.3%) occurred: one surgical failure requiring revision to reverse shoulder arthroplasty, one persistent painful shoulder without functional improvement, and one infection that was resolved with treatment. The Gerber test remained positive in 9 patients (42.9%), and the belly press test remained positive in 3 patients (14.3%).
Conclusion:
LD transfer for irreparable subscapularis tendon tears leads to significant improvements in shoulder function, pain reduction, and patient satisfaction. While it offers a viable option, residual subscapularis insufficiency persists in a subset of patients.
