Outcome comparison of arthroscopic latissimus dorsi tendon transfer and muscle advancement for irreparable rotator cuff tear: a systematic review.

PURPOSE: To compare the clinical outcomes and complications between latissimus dorsi tendon transfer (LDTT) and muscle advancement (MA) for irreparable rotator cuff tears (IRCTs).

METHODS

A PRISMA-guided systematic review included 24 studies (956 shoulders: 750 LDTT, 206 MA) from MEDLINE, Embase, and Cochrane Library (searched October 2024). Eligible studies involved arthroscopic-assisted procedures for Patte stage 3 tears with Goutallier stage 3-4 fatty degeneration and ≥12-month follow-up. The analyzed outcomes included functional scores (Constant-Murley, UCLA, ASES), pain (VAS), acromiohumeral distance (AHD), range of motion (ROM), and complications. Risk of bias was assessed using the ROBINS-I and Cochrane tools, and statistical synthesis employed RevMan and R.

RESULTS

In this analysis, 24 studies (1 RCT, 13 cohort, 10 case series) involving 956 shoulders were included: 206 in the MA group (mean age 64.6 years, mean follow-up 19.7 months) and 750 in the LDTT group (mean age 60.8 years, mean follow-up 31.2 months). Both techniques resulted in significant functional improvement. Comparative analysis revealed no significant differences in the pooled mean improvements for the Constant-Murley Score, UCLA score, ASES score, VAS pain, forward flexion, or abduction, however, the LDTT group demonstrated significantly greater improvement in external rotation. The MA group experienced significantly higher rates of total complications (25.7% vs. 18.0%, P = 0.0206) and failure/retear/reoperation (20.8% vs. 8.9%, P = 0.0003). The rates of infection, nerve palsy, and stiffness were comparable between groups. Significant heterogeneity was observed in most continuous outcomes.

CONCLUSIONS

LDTT and MA effectively restore shoulder function in IRCTs; however, their mechanisms differ. The LDTT excels in dynamic biomechanical compensation for external rotation, whereas MA achieves superior static joint stability. LDTT's lower retear rates and higher complication risks associated with MA highlight the need for patient-specific surgical selection.