Tendon Transfers for Massive Irreparable Rotator Cuff Tear

Management of massive irreparable rotator cuff tears can be challenging. In patients who are not candidates for shoulder arthroplasty, either because of age or higher levels of activity, tendon transfers remain a good surgical option to reconstruct the deficient rotator cuff. The latissimus dorsi is the most commonly described tendon transfer for posterior-superior rotator cuff deficiency. Additional options include teres major and lower trapezius transfers. For anterior-superior irreparable rotator cuff tears, the pectoralis major transfer, whether superficial or deep to the conjoined tendon, is the most commonly described transfer. Additional transfers include those of pectoralis minor, teres major, and latissimus dorsi. The purpose of this article is to provide an evidence-based overview of the different types of tendon transfers that have been described to reconstruct massive, irreparable rotator cuff tears.