Static versus dynamic superior augmentation in anterior latissimus dorsi and teres major tendon transfer for anterosuperior irreparable rotator cuff tears with narrow acromiohumeral distances

Introduction This study compared outcomes between static superior augmentation using superior capsular reconstruction (SCR) and dynamic augmentation using arthroscopy-assisted middle trapezius tendon transfer (aMTT) combined with anterior latissimus dorsi and teres major (aLDTM) tendon transfer in anterosuperior irreparable rotator cuff tears (ASIRCTs) with narrow acromiohumeral distance (AHD). Methods Thirty-four patients with ASIRCTs and preoperative AHD <6 mm who underwent aLDTM tendon transfer between 2018 and 2023 were retrospectively reviewed. Group S ( n = 14) underwent aLDTM with SCR, and Group M ( n = 20) underwent aLDTM with aMTT. Clinical outcomes included pain, patient-reported outcome measures, active range of motion, and muscle strength. Radiological outcomes included AHD, Hamada grade, and structural integrity. Results Both groups demonstrated significant postoperative improvements. Compared with Group S, Group M demonstrated significantly greater improvements from baseline in forward elevation (57.0 ± 12.6° vs 43.6 ± 19.1°, p = 0.024), forward elevation strength (11.6 ± 4.6 N vs 7.1 ± 3.3 N, p = 0.002), and AHD (3.6 ± 3.5 mm vs −0.1 ± 0.9 mm, p < 0.001). Structural failure rates were significantly higher in Group S (64.3% vs 10.0%, p < 0.001). Conclusions Dynamic superior augmentation with aMTT provided superior restoration of superior stability, overhead function, and structural durability compared with SCR in ASIRCTs with narrow AHDs. Level of evidence: Level III, retrospective comparative study.