Effect of Subscapularis Integrity on Functional Recovery After Posterior Latissimus Dorsi Tendon Transfer for Posterior–Superior Irreparable Rotator Cuff Tears

Why It Matters

Subscapularis integrity appears to enhance functional outcomes after LD transfer, guiding surgeons toward more precise patient selection and pre‑operative planning.

Key Takeaways

• Posterior LD transfer improves pain and function in PSIRCT patients.
• Intact subscapularis yields higher Constant and ASES scores post‑op.
• Retear rates similar regardless of subscapularis condition.
• ROM gains comparable; internal rotation deficits normalize after surgery.
• Study supports assessing subscapularis integrity when planning LD transfer.

Pulse Analysis

Posterior‑superior irreparable rotator cuff tears represent a growing clinical challenge, especially in active adults whose shoulder function is compromised by massive supraspinatus and infraspinatus defects. Traditional options—partial repair, superior capsule reconstruction, or reverse shoulder arthroplasty—each carry trade‑offs in durability, biomechanics, and postoperative rehabilitation. The posterior latissimus dorsi tendon transfer has emerged as a biomechanically sound alternative, restoring the posterior force couple and enhancing external rotation without the extensive bone work required for arthroplasty. Recent literature highlights its capacity to deliver meaningful pain relief and functional gains, positioning it as a valuable tool in the shoulder surgeon’s armamentarium.

A critical, yet often underappreciated, factor influencing the success of LD transfer is the condition of the subscapularis tendon. Acting as the anterior stabilizer of the glenohumeral joint, an intact subscapularis maintains the anterior‑posterior force balance essential for optimal shoulder kinematics. The current retrospective study of 53 patients demonstrates that while both intact and torn subscapularis groups experience significant improvements, those with a preserved subscapularis achieve markedly higher Constant and ASES scores. This suggests that the anterior cuff’s integrity amplifies the functional benefits of posterior LD transfer, likely by preserving joint centering and reducing compensatory muscle fatigue.

For clinicians, these findings translate into a more nuanced pre‑operative algorithm: thorough imaging and intra‑operative assessment of subscapularis integrity should inform candidacy for LD transfer and may prompt concurrent subscapularis repair when feasible. Rehabilitation protocols can be tailored, emphasizing early protection of the repaired subscapularis while progressing posterior strengthening. Future prospective trials are needed to validate these results and explore long‑term survivorship, but the current evidence already supports integrating subscapularis evaluation into decision‑making, ultimately improving patient outcomes and resource utilization.