The treatment of massive, irreparable rotator cuff tears remains controversial today since there is no consensus on the ideal treatment option. This investigation aimed to prospectively evaluate and compare the outcomes of arthroscopic-assisted latissimus dorsi transfer and superior capsular reconstruction in treatment of massive, irreparable rotator cuff tears.
Forty-two patients at an average age of 62.8 years with massive, irreparable rotator cuff tears 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). The patients were followed up prospectively for 31 months on average. One patient in the SCR group was lost to follow-up. The outcomes were evaluated with American Shoulder and Elbow Surgeons(ASES), Western Ontario Rotator Cuff Index(WORC), Visual Analog Scale(VAS) and Constant scores clinically and with Acromio-Humeral distance (AHD) measurements radiologically.
Both groups displayed improved results in ASES, WORC, Constant and VAS scores in the final follow-up (p<.001). LDT group had significantly better results in AHD (p=.006). SCR group yielded significantly higher improvements in ASES(p=.007) and Constant(p=.008) scores. The rate of successful pseudoparalysis treatment was 45%(5/11) in LDT group and 92%(12/13) in SCR group(p=.011). The graft failure rate was 5% (1 patient) in each group postoperatively; 1 patient in SCR group had a traumatic graft rupture and 1 patient in LDT group was complicated with septic arthritis which required graft removal.
Both SCR and LDT yielded promising short-term results in treatment of massive, irreparable rotator cuff tears in this study. The SCR group displayed better overall outcomes clinically, particularly in the pseudoparalytic shoulders, while the LDT group displayed better radiological results.

Copyright © 2021. Published by Elsevier Inc.