Tendon Transfer Techniques for Rotator Cuff Tears

Overseen By Ashfaq S Hasan, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Maryland, Baltimore

Disqualifiers: Severe arthritis, Nerve injury, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: Surgical procedure

84 Participants Needed

Trial Summary

What is the purpose of this trial?

This is a prospective randomized study on using muscle tendons to repair tears of the muscles on the shoulder. There are 3 muscles covering the shoulder joint- supraspinatus, infraspinatus and subscapularis. Large tears involving these muscles can be treated by using some muscle from another location of the body known as Tendon transfer techniques. These muscle tendons may be from the lower back (Latissimus Dorsi), upper pack (lower trapezius) or chest (pectoralis). There are currently no studies to show which tendon transfer technique has better outcomes. This study comprises two trials and a total of 84 participants would be enrolled. Each trial comparing the patient reported outcomes between two tendon transfer techniques. Large tears involving the supraspinatus and infraspinatus would be repaired using either the Latissimus dorsi technique or Lower trapezius technique. 21 patients would be randomly assigned to either groups. The second trial would be comparing the Latissimus dorsi technique and pectoralis technique in large tears of the subscapularis muscle. Another 21 patients would be randomly assigned to either groups. The investigators are studying to see if the Lower Trapezius and Pectoralis transfer techniques for muscle tear repairs would have better post-surgical outcomes compared with Latissimus Dorsi transfer technique. For both trials, participants would be followed up for 2 years and post-surgical outcomes would be compared between treatment groups.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the study team or your doctor.

What data supports the effectiveness of the treatment Latissimus Dorsi Tendon Transfer Technique for rotator cuff tears?

Research shows that Latissimus Dorsi Tendon Transfer can improve shoulder function in cases of massive, irreparable rotator cuff tears, especially when other surgeries have failed. It is particularly useful for improving shoulder movement and reducing pain. ^{1 2 3 4 5}

Is tendon transfer surgery for rotator cuff tears safe?

Research suggests that tendon transfer surgeries, like the latissimus dorsi tendon transfer, are generally considered safe for treating massive rotator cuff tears, with studies indicating satisfactory outcomes in the mid-term follow-up. ^{1 2 6 7 8}

How is the tendon transfer treatment for rotator cuff tears different from other treatments?

Tendon transfer techniques for rotator cuff tears, such as the Latissimus Dorsi, Lower Trapezius, and Pectoralis Major transfers, are unique because they involve moving a tendon from one part of the body to another to restore shoulder function when the rotator cuff is irreparable. These techniques are often used after other surgeries have failed and are tailored to address specific deficits in shoulder movement, such as loss of elevation or rotation. ^{3 5 9 10 11}

Research Team

Ashfaq S Hasan, MD

Principal Investigator

U of Maryland Baltimore

Eligibility Criteria

This trial is for adults aged 18-65 with massive, irreparable rotator cuff tears and minimal shoulder arthritis. It's not for those with axillary nerve injury, deltoid deficiency, pseudo paralysis, severe shoulder arthritis, a history of tendon transfer or deep infection after surgery.

Inclusion Criteria

I have a severe, unfixable tear in my shoulder's rotator cuff.

My shoulder tendon tear cannot be repaired.

My shoulder arthritis is minimal or not present.

Exclusion Criteria

I have a tear in my shoulder tendon that cannot be fixed.

I have had a deep infection in my shoulder after surgery.

You have a missing or underdeveloped deltoid muscle.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo tendon transfer surgery using either Latissimus Dorsi, Lower Trapezius, or Pectoralis techniques

Surgical procedure

Follow-up

Participants are monitored for post-surgical outcomes and compared between treatment groups

2 years

Regular follow-up visits

Treatment Details

Interventions

• Latissimus Dorsi Tendon Transfer Technique
• Lower Trapezius Tendon Transfer Technique
• Pectoralis Tendon Transfer Technique

Trial Overview The study compares three muscle tendon transfer techniques to repair large shoulder muscle tears: using tendons from the lower back (Latissimus Dorsi), upper back (Lower Trapezius), or chest (Pectoralis). Outcomes of two different pairings will be evaluated over two years.

Participant Groups

Group I: Cuff tear without subscapularis tear-Lower Trapezius group Active Control 1 Intervention

Rotator cuff tears excluding the subscapularis muscle repaired using Lower Trapezius tendon

Group II: Cuff tear without subscapularis tear-Latissimus Dorsi group Active Control 1 Intervention

Rotator cuff tears excluding the subscapularis muscle repaired using Latissimus Dorsi tendon

Group III: Cuff tear involving subscapularis tear-Latissimus Dorsi group Active Control 1 Intervention

Rotator cuff tears involving the subscapularis muscle repaired using Latissimus Dorsi tendon

Group IV: Cuff tear involving subscapularis tear-Pectoralis group Active Control 1 Intervention

Rotator cuff tears involving the subscapularis muscle repaired using Pectoralis tendon

Latissimus Dorsi Tendon Transfer Technique is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Latissimus Dorsi Transfer for:

• Irreparable rotator cuff tears involving the supraspinatus and infraspinatus tendons

Approved in European Union as Latissimus Dorsi Transfer for:

• Massive rotator cuff tears involving the supraspinatus and infraspinatus tendons

Approved in Canada as Latissimus Dorsi Transfer for:

• Posterosuperior irreparable rotator cuff tears

Who Is Running the Clinical Trial?

University of Maryland, Baltimore

Lead Sponsor

Trials

729

Recruited

540,000+

Findings from Research

Latissimus dorsi tendon transfer (LDT) significantly improves shoulder movement in patients with massive, irreparable posterosuperior cuff tears, as shown by 3-D motion analysis conducted on nine patients before and after surgery.

The improvement in shoulder motion after LDT does not appear to be due to increased activity of the latissimus dorsi muscle, suggesting that the mechanism may involve a depression of the humeral head into the glenoid cavity instead.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Three-dimensional analysis of the shoulder motion in patients with massive irreparable cuff tears after latissimus dorsi tendon transfer (LDT). Ippolito, G., Serrao, M., Napoli, F., et al.[2019]

The article discusses a novel technique for managing a rare complication of latissimus dorsi tendon transfer, specifically a rupture of the transferred tendon, which is particularly relevant for young, active patients with massive rotator cuff tears.

The proposed solution involves an arthroscopic, anatomic bridging reconstruction using an acellular human dermal matrix allograft, offering a potential new approach to address this complication effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Revision of a Failed Latissimus Dorsi Transfer for a Massive Rotator Cuff Tear With Arthroscopic Anatomic Bridging Reconstruction Using an Acellular Human Dermal Matrix Allograft. John, R., Coady, CM., Wong, I.[2020]

Tendon transfer techniques for irreparable rotator-cuff tears have evolved to address various shoulder dysfunctions beyond just external rotation deficits, with specific transfers indicated for different types of tears.

The latissimus dorsi, inferior trapezius, and pectoralis major transfers are recommended after failed primary surgeries, with latissimus dorsi being suitable for partial loss of elevation and inferior trapezius for external rotation deficits; however, in cases of total loss of elevation, these transfers may need to be combined with reverse arthroplasty for effective restoration.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tendon transfers in rotator-cuff surgery. Kany, J.[2020]

The study found that transferring the lower trapezius (LT) muscle to the infraspinatus insertion site provides better abduction and external rotation moment arms compared to the latissimus dorsi (LD) transfer, suggesting a biomechanical advantage for LT in improving shoulder function.

However, the LT transfer resulted in significantly larger muscle strains, indicating a risk of overtensioning, which may require the use of a tendon allograft to ensure safety and effectiveness during rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Biomechanics of lower trapezius and latissimus dorsi transfers in rotator cuff-deficient shoulders. Reddy, A., Gulotta, LV., Chen, X., et al.[2019]

The study reviews various latissimus dorsi tendon transfer techniques for treating shoulder issues, highlighting their applications in conditions like obstetric palsy and irreparable rotator cuff tears.

It emphasizes the importance of tailored surgical planning and approaches for each technique, providing valuable insights for surgeons considering these procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Latissimus dorsi tendon transfers: a historical journey. Turkmen, I., Koraman, E., Poyanlı, O.[2021]

In a study of 18 patients with irreparable rotator cuff tears, latissimus dorsi tendon transfer resulted in shoulder range of motion (ROM) comparable to their healthy shoulders, indicating effective functional restoration after surgery.

The procedure also showed increased activation of the latissimus dorsi muscle during specific movements, suggesting that the muscle's contraction contributes positively to shoulder function, despite not fully normalizing scapulothoracic joint movements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The latissimus dorsi tendon functions as an external rotator after arthroscopic-assisted transfer for massive irreparable posterosuperior rotator cuff tears. Galasso, O., Mantovani, M., Muraccini, M., et al.[2021]

In a study of 23 patients with irreparable massive rotator cuff tears, latissimus dorsi tendon transfer resulted in significant improvements in shoulder function and range of motion at an average follow-up of 4.7 years.

While the procedure showed satisfactory clinical outcomes, complications occurred in 21.7% of cases, including re-tears and infections, highlighting the need for careful monitoring post-surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mid-term Clinical and Radiological Outcomes of Latissimus Dorsi Tendon Transfer in Massive Rotator Cuff Tears. Suh, D., Ji, JH., Tankshali, K., et al.[2022]

Tendon transfer options, such as lower trapezius and latissimus dorsi transfers, can effectively treat irreparable rotator cuff tears (RCTs) by restoring shoulder function and relieving pain, with recent studies showing promising results for the lower trapezius transfer.

The latissimus dorsi transfer has been found to be a safe and effective option not only for posterior-superior RCTs but also for addressing subscapularis insufficiency, highlighting the importance of selecting the appropriate donor tendon for optimal outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Role of Tendon Transfers for Irreparable Rotator Cuff Tears. Clark, NJ., Elhassan, BT.[2022]

In a study of 42 patients with massive irreparable rotator cuff tears, using a modified technique for latissimus dorsi tendon transfer that included bone harvesting resulted in significantly better clinical outcomes compared to the traditional method, with higher Constant and ASES scores.

The modified technique also led to a lower rate of tendon rupture, with no complete ruptures observed in the modified group, compared to four in the traditional group, indicating improved fixation stability and overall effectiveness of the procedure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique to improve tendon transfer integrity. Moursy, M., Forstner, R., Koller, H., et al.[2022]

In a study of 42 patients with massive irreparable rotator cuff tears, using a modified technique for latissimus dorsi tendon transfer that included bone harvesting resulted in significantly better clinical outcomes compared to the traditional method, with higher Constant and ASES scores.

The modified technique also led to a lower rate of tendon rupture, with no complete ruptures observed in the modified group, compared to four in the traditional group, indicating improved fixation stability and overall effectiveness of the procedure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique to improve tendon transfer integrity: surgical technique. Tauber, M., Moursy, M., Forstner, R., et al.[2022]

The study introduces an innovative arthroscopic-assisted technique for lower trapezius transfer, which is used to reconstruct massive irreparable posterior-superior rotator cuff tears, enhancing the surgical approach previously described.

This technique is augmented with an Achilles tendon allograft, potentially improving the effectiveness of the reconstruction and offering a less invasive option compared to traditional methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Arthroscopic-Assisted Lower Trapezius Tendon Transfer for Massive Irreparable Posterior-Superior Rotator Cuff Tears: Surgical Technique. Elhassan, BT., Alentorn-Geli, E., Assenmacher, AT., et al.[2022]

References

1. Germany pubmed.ncbi.nlm.nih.gov

Three-dimensional analysis of the shoulder motion in patients with massive irreparable cuff tears after latissimus dorsi tendon transfer (LDT). [2019]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Revision of a Failed Latissimus Dorsi Transfer for a Massive Rotator Cuff Tear With Arthroscopic Anatomic Bridging Reconstruction Using an Acellular Human Dermal Matrix Allograft. [2020]

3. France pubmed.ncbi.nlm.nih.gov

Tendon transfers in rotator-cuff surgery. [2020]

4. United States pubmed.ncbi.nlm.nih.gov

Biomechanics of lower trapezius and latissimus dorsi transfers in rotator cuff-deficient shoulders. [2019]

5. France pubmed.ncbi.nlm.nih.gov

Latissimus dorsi tendon transfers: a historical journey. [2021]

6. Germany pubmed.ncbi.nlm.nih.gov

The latissimus dorsi tendon functions as an external rotator after arthroscopic-assisted transfer for massive irreparable posterosuperior rotator cuff tears. [2021]

7. Korea (South) pubmed.ncbi.nlm.nih.gov

Mid-term Clinical and Radiological Outcomes of Latissimus Dorsi Tendon Transfer in Massive Rotator Cuff Tears. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

The Role of Tendon Transfers for Irreparable Rotator Cuff Tears. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique to improve tendon transfer integrity. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique to improve tendon transfer integrity: surgical technique. [2022]

11. Netherlands pubmed.ncbi.nlm.nih.gov

Arthroscopic-Assisted Lower Trapezius Tendon Transfer for Massive Irreparable Posterior-Superior Rotator Cuff Tears: Surgical Technique. [2022]