Tendon transfers to help you avoid reverse shoulder replacement

Treatment of irreparable rotator cuff tears (RCTs) with minimal degenerative changes in an active, high demand patient remains challenging. While reverse shoulder replacement is an option, durability in the setting of high demand use remains unknown. Alternatively, tendon transfers are an attractive alternative that require no long term restrictions on use. The latissimus dorsi and pectoralis major are typically described as treatment options for irreparable posterior superior and anterior superior RCTs respectively. Recently, anatomic and biomechanical studies have questioned the use of these transfers suggesting that the lower trapezius may be the ideal transfer for posterior superior tears. Similarly, the latissimus dorsi is a more anatomic transfer to reconstruct anterior superior tears. As such, the lower trapezius and latissimus have become our standard treatment options for posterior superior and anterior superior irreparable tears respectively. Tendon transfers represent an attractive alternative to reverse shoulder replacement when treating a patient with an irreparable tear and minimal arthritis.