Favorable results of latissimus dorsi and teres major tendons transfer for anterosuperior irreparable rotator cuff tears do not depend on initial fatty infiltration of inferior subscapularis muscle - 06/06/26
, Chaemoon Lim, Jung Gon Kim, Bo Taek Kim, Seung Jin KimAbstract |
Background |
The inferior subscapularis (SSC) contributes to anterior stability and internal rotation (IR) in anterosuperior irreparable rotator cuff tears (ASIRCTs). However, the clinical impact of fatty degeneration of the inferior SSC after anterior latissimus dorsi and teres major (aLDTM) tendon transfer is not well understood. The aim of this study was to evaluate the influence of fatty infiltration of the inferior SSC on baseline function and postoperative outcomes following aLDTM tendon transfer.
Hypothesis |
We hypothesized that severe fatty degeneration of the inferior SSC would be associated with worse preoperative function, but that aLDTM tendon transfer would yield favorable postoperative outcomes regardless of the extent of SSC fatty degeneration.
Material and methods |
Seventy patients with ASIRCTs treated with aLDTM tendon transfer were retrospectively reviewed and categorized by modified Goutallier grading for the SSC into grade 4 (n = 37) and grade 5 (n = 33) groups. Clinical and radiological outcomes were compared preoperatively and at the final follow-up. Improvement magnitudes (Δ values) were analyzed, and correlations between changes in acromiohumeral distance (ΔAHD) and IR strength (ΔIR strength) were assessed.
Results |
The grade 5 group had significantly worse preoperative Constant and Activities of Daily Living involving Internal Rotation scores, IR range of motion, and IR strength than the grade 4 group. Despite these baseline differences, both groups demonstrated significant postoperative improvement, with no significant differences at final follow-up. Among Δ values, ΔIR strength and ΔAHD differed significantly between groups. A moderately positive correlation was identified between ΔIR strength and ΔAHD ( r = 0.32, p = 0.008), suggesting a biomechanical association between humeral head re-centering and IR recovery.
Discussion |
Although severe inferior SSC degeneration was associated with poorer baseline function, patients achieved comparable postoperative outcomes after aLDTM tendon transfer. These findings support the use of aLDTM tendon transfer as an effective compensatory procedure that restores joint mechanics and functional capacity regardless of preoperative SSC status.
Level of evidence |
III; retrospective comparative study.
Le texte complet de cet article est disponible en PDF.Keywords : Massive rotator cuff tears, Goutallier’s fatty muscle degeneration gradation, Hamada grade preoperatively and postoperatively, Patte stage III (medial retraction of the tendon extending to the level of the glenoid cavity), Internal rotation strength, Standard deltopectoral approach
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