Background
Tendon transfers (TT) can be successful for the management of selected functional posterosuperior irreparable cuff tears (FIRCT). However, when these procedures fail to provide adequate pain relief or functional improvements, reverse shoulder arthroplasty (RSA) is commonly considered as the next treatment option. The effect of prior TT on RSA remains largely unknown. The purpose of this investigation was to evaluate the outcomes of RSA after previous TT performed for posterosuperior FIRCTs, and to determine the effect of various TT types on RSA.
Methods
A retrospective review of two institutional databases identified 33 patients who underwent a RSA implantation between 2006 and 2019 with a previous failed tendon transfer (FTT) of the shoulder, and at least two-years of clinical follow-up. FTTs included 21 latissimus dorsi transfers (LDT), 6 latissimus dorsi and teres major transfers (LD-TM), and 6 lower trapezius transfers (LTT). RSA were performed at an average of 5.5 years (range, 0.3 to 28 years) after FTT with a mean follow-up of 4.1 ± 2.0 years. Outcomes evaluated included visual analog scale (VAS) for pain, range of motion (ROM), Constant-Murley-Score absolute (aCS) and relative (rCS) scores, American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), complications, and implant survivorship free of reoperation or revision.
Results
RSA significantly improved pain and function, with improvements in pain (VAS 6.2 preoperatively vs. 2.2 at most recent follow-up, P < .001), active elevation (85 vs. 111 degrees, P < .001), ASES score (51 vs. 74, P = .001), aCS (34 vs. 48, P = .003), and rCS (42 vs. 59, P = .002), exceeding the minimal clinically important difference threshold. There were 7 (21%) complications across entire cohort with dislocation (n = 3; 9.1%) as the most common complication. When compared across TT groups, LD-TM had the highest complication (3 shoulders, 50%), followed by LTT (1 shoulder, 16.7%), and LDT with the lowest rate (3 shoulders, 14.3%; p=0.037). Survivorship free of revision or reoperation was estimated to be 90.1% at 1 year, 84.9 at 2 years, and 71.2% at 5 years, with no differences among TT groups (p = 0.654).
Conclusions
Reverse shoulder arthroplasty can serve as a viable salvage option for failed tendon transfer procedures. At mid-term follow-up, RSA led to significant improvements in pain, ROM, and patient-reported outcomes. Patients with prior LD-TM transfers may have a higher complication rate, but no other differences were found between tendon transfer groups.