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.