Preoperative Pseudoparesis Is Not Associated With Inferior Outcomes After Anterior Latissimus Dorsi and Teres Major Transfer for Irreparable Anterosuperior Rotator Cuff Tears: A Propensity Score-Matched Analysis.

BACKGROUND

The prognostic relevance of preoperative pseudoparesis after combined anterior latissimus dorsi and teres major transfer (aLDTM) for irreparable anterosuperior rotator cuff tears (IASRCTs) has not been examined in a matched comparison. We hypothesized that, after propensity score matching, final outcomes would not differ significantly between groups.

METHODS

This retrospective comparative cohort study reviewed patients undergoing aLDTM for IASRCT between April 2015 and January 2024. Pseudoparesis was defined a priori as active forward elevation ≥45° and <90° with preserved passive elevation after local anesthetic injection and without neurologic deficit (n=57); active forward elevation ≥90° defined the comparator group (n=183). True pseudoparalysis (<45°) and advanced arthropathy (Hamada grade >2) were excluded. One-to-one propensity score matching on age, sex, body mass index, diabetes, hypertension, previous cuff repair, acromiohumeral distance (AHD), Hamada grade, intraoperative reparable infraspinatus tear, and fatty infiltration of the four rotator cuff muscles produced 57 pairs (all absolute standardized mean differences <0.10). Outcomes included clinical scores (VAS, ADLIR, Constant, UCLA, ASES), range of motion, strength, subscapularis-specific tests, and tendon integrity on 2-year postoperative MRI. Mean follow-up was 57.0 ± 20.0 months.

RESULTS

Both groups improved in clinical scores, forward elevation, abduction, internal rotation, and most strength measures (all adjusted P < .001); external rotation range of motion did not change significantly. Final clinical scores, range of motion, and strength showed no significant between-group differences (all adjusted P ≥ .569). The pseudoparesis group showed larger gains in forward elevation (69° ± 26° vs 35° ± 28°, adjusted P < .001) and abduction (48° ± 29° vs 29° ± 27°, adjusted P = .007). Subscapularis-specific tests and AHD did not differ between groups. Retear on 2-year postoperative MRI occurred in 3/57 (5.3%) and 4/57 (7.0%) (adjusted P = 1.000).

CONCLUSION

In this propensity score-matched analysis, the pseudoparesis group had lower baseline elevation by definition, whereas final clinical, range-of-motion, strength, and structural outcomes did not differ between groups after aLDTM for IASRCT. These findings should not be extrapolated to true pseudoparalysis or advanced arthropathy.