I'd like to thank my co-authors and the conference for letting me present. I have no disclosures. No other people in the study had any disclosures relevant to this talk. Massive irreparable rotator cuff tears are a particularly challenging scenario in young patients. Latissimus dorsi tendon transfer and arthroscopic superior capsule reconstruction have been demonstrated to be effective treatments, but no previous study prior to ours has compared these two procedures. Our goal was to determine if one procedure was more effective in providing improved outcomes in terms of range of motion and patient-reported outcomes. And we hypothesized that both treatment groups would have similar results. Three surgeons from two institutions contributed patients to this retrospective study. No surgeon performed both techniques, and patient treatment was decided based on attending surgeon preference. All patients underwent either arthroscopic superior capsule reconstruction or latissimus dorsi tendon transfer. All patients were required to have no evidence of osteoarthritis as defined by hematograde of two or less, as well as evidence on MRI of a massive irreparable rotator cuff tear as defined by the Gotelier classification. Every patient had failed some sort of prior treatment, including either prolonged physical therapy or previous rotator cuff repair. A minimum of six-month follow-up was required in the study. Standard surgical techniques for both procedures was completed. The latissimus transfer was performed open, while the superior capsule reconstruction was performed arthroscopically. Two commercially available graft types were used for the arthroscopic superior reconstruction. Both preoperative and postoperative forward flexion and external rotation were compared. Patients reported their outcomes based on the ASES shoulder score, visual analog scale, and subjective shoulder value. These were only assessed postoperatively, and they were assessed either at the last clinic visit or via phone call for follow-up. In total, 14 patients with 16 shoulders were included in the latissimus transfer group. Superior capsule reconstruction group included 27 patients. The patients were similar in terms of gender, age, and laterality. A significantly greater number of patients had undergone previous surgery in the latissimus transfer group, and a significantly greater number of patients had subscapularis tears in the arthroscopic superior capsule reconstruction group, although this did reflect attending surgeon preference, as the surgeon performing the latissimus transfers required intact subscap at the time of surgery. It should be noted that the subscap tears were all repairable at the time of arthroscopic superior capsule reconstruction. The mean follow-up was approximately a year and a half in both groups. The post-op improvement in forward flexion on average was 14 degrees in the latissimus transfer group. This was not found to be significant. The superior capsule reconstruction group did achieve an improvement of 52 degrees on average, which was significant. And in comparison between the two groups, the superior capsule reconstruction group achieved significantly greater forward flexion gains. When assessing external rotation, the latissimus transfer group achieved on average 19.4 degrees of improvement, and this was found to be significant. The superior capsule reconstruction group essentially remained unchanged. And in assessing between the two groups, the latissimus transfer did result in significantly greater external rotation gains compared to the superior capsule reconstruction. Again, patient-reported outcome scores were only assessed post-operatively. There was no significant difference between the two groups for any outcome assessment. Superior capsule reconstruction group did achieve a mean value of 72.6 in the subjective shoulder value, while this latissimus transfer was 55, turning towards but not achieving significance. So in conclusion, latissimus transfer and superior capsule reconstruction are both viable options for patients with massive irreparable rotator cuff tears. And our short-term study suggests that superior capsule reconstruction may offer greater improvement in forward flexion, while latissimus transfer may offer greater improvements in external rotation. Importantly, though, both treatments demonstrated similar subjective outcomes. We do look forward to adding patients to our study and contributing longer-term outcome assessment in order to determine a superior technique. Thank you.

comparison

latissimus dorsi tendon transfer

arthroscopic superior capsule reconstruction

massive irreparable rotator cuff tears

young patients