Comparative outcomes and complication rates of lower trapezius versus latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears: a systematic review.

BACKGROUND

Latissimus dorsi transfer (LDT) and lower trapezius transfer (LTT) for irreparable posterosuperior rotator cuff tears have been shown to have favorable outcomes. There has been no systematic comparison of clinical outcomes between the 2 techniques. We aimed to compare clinical outcome measures, complications, and rates of conversion to reverse shoulder arthroplasty between LDT and LTT with a minimum of 1-year post-operative follow-up.

METHODS

We performed a systematic review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, querying MEDLINE (PubMed) and Embase databases for studies reporting outcomes and complications following LDT and LTT with a minimum of 1-year follow-up. We assessed the methodological quality of each study using the MINORS score and extracted patient demographics, clinical, and patient-reported outcome data.

RESULTS

Sixty-nine studies, including 2,476 patients (2,495 shoulders), met the inclusion criteria. The LDT and LTT groups consisted of 1,834 and 661 shoulders, respectively. The weighted mean age ( ± standard deviation) was 60.2 ± 4.1 years, follow-up was 49.2 ± 23.7 months, and 33.4% were female. Compared with LTT, LDT group showed a greater improvement in the Constant score (28.9 vs. 23.6, P < .01), University of California Los Angeles scores (15.1 vs. 8.5, P = .03), and lower visual analog scale scores for pain (-4.4 vs. -3.3, P = .02). LTT group gained more active external rotation (21.9° vs. 15.2°, P < .01) compared to the LDT group. Active forward elevation, active abduction, American Shoulder and Elbow Surgeons and Activities of Daily Living External Rotation scores, patient satisfaction, complication rates, and conversion rates to reverse shoulder arthroplasty were similar between groups, with the exception of a higher incidence of nerve injury in the LDT group (0.8% vs. 0%, P < .01).

CONCLUSION

Both LDT and LTT are viable options for irreparable posterosuperior rotator cuff tears. While differences in reported outcomes were observed across studies-such as greater improvements in external rotation in LTT cohorts and slightly higher improvements in certain patient-reported outcomes in LDT cohorts-these findings are derived from indirect comparisons of heterogeneous populations and should be interpreted with caution.