Dual reconstruction, combined anterior latissimus dorsi with teres major and posterior lower trapezius tendon transfer, for massive irreparable rotator cuff tears: a case report

IntroductionReverse total shoulder arthroplasty has proven to be a successful choice for massive irreparable rotator cuff tears (MIRCTs). However, a joint-preserving method should be considered when the patient exhibits minimal arthritis. A different type of tendon transfer is available for each specific type of irreparable rotator cuff tear. Nevertheless, no single tendon transfer has proven entirely satisfactory, especially when addressing MIRCTs, particularly those involving the subscapularis, supraspinatus, and infraspinatus.Case descriptionThe patient is 60-year-old right-handed fisherman experiencing chronic pain and weakness in the right shoulder. Radiography showed no signs of arthritis in the glenohumeral joint, while magnetic resonance imaging (MRI) revealed MIRCTs in the subscapularis, supraspinatus, and infraspinatus with atrophy and high-grade fatty infiltration. Considering the patient's occupation and desire to maintain strength postoperatively, dual reconstruction was chosen, combining anterior Latissimus Dorsi and Teres Major (LDTM) with posterior Lower Trapezius Tendon (LTT) transfer. The postoperative outcome at 2 years demonstrated promising improvements in clinical scores, range of motion, and strength, with no progression in arthritis and intact transferred tendon integrity. The patient successfully returned to work.ConclusionWe report promising clinical outcome two years postoperatively for patient with MIRCT, involving the subscapularis, supraspinatus, and infraspinatus, who underwent combined anterior LDTM with posterior LTT transfer. Dual reconstruction may offer a useful joint-preserving option for young patients with intact or minimal glenohumeral joint arthritis, particularly those who are too young or have physically demanding professions.