These authors reviewed forty-two patients at an average age of 62.8 years with massive, irreparable rotator cuff tears that were randomized in two treatment groups. 21 patients underwent arthroscopic assisted latissimus dorsi tendon transfer (LDT) and 21 patients underwent arthroscopic assisted superior capsular reconstruction (SCR).
At an average of 31 months after surgery both groups displayed improved results in ASES, WORC, Constant and VAS scores. The SCR group yielded significantly higher improvements in clinical scores.
For the LDT group flexion improved from 95 to 140 degrees
For the SCR group flexion improved from 101 to 162 degrees
For comparison, a series of patients with irreparable rotator cuff tears treated with a much simpler "smooth and move" procedure(see this link) showed improvement in active flexion from 102 to 126 degrees. The technique of the smooth and move procedure for irreparable rotator cuff tears is shown in this link.
Comment: The treatment of massive irreparable cuff tears needs to be individualized for each patient. While major procedures, such reverse total shoulder, latissimus dorsi tendon transfer, and superior capsular reconstruction can be effective, patients with retained active elevation can be effectively managed by a lesser and safer procedure, the smooth and move, without the down time associated with major reconstructions.
