title: Irreparable Rotator Cuff Tears: Restoring Joint Kinematics by Tendon Transfers.
abstract: BACKGROUND
  Tendon transfers can be a surgical treatment option in managing younger, active patients with massive irreparable rotator cuff tears. The purpose of this article is to provide an overview of the use of tendon transfers to treat massive irreparable rotator cuff tears and to summarize clinical outcomes.
  
  
  METHODS
  A selective literature search was performed and personal surgical experiences are reported.
  
  
  RESULTS
  Latissimus dorsi transfers have been used for many years in the management of posterosuperior rotator cuff tears with good reported clinical outcomes. It can be transferred without or with the teres major (L'Episcopo technique). Many surgical techniques have been described for latissimus dorsi transfer including single incision, double incision, and arthroscopically assisted transfer. Transfer of the pectoralis major tendon is the most common tendon transfer procedure performed for anterosuperior rotator cuff deficiencies. Several surgical techniques have been described, however transfer of the pectoralis major beneath the coracoid process has been found to most closely replicate the force vector that is normally provided by the intact subscapularis.
  
  
  CONCLUSIONS
  Tendon transfers can be used successfully in the management of younger patients with massive irreparable rotator cuff tears and minimal glenohumeral arthritis. Improvements in clinical outcomes scores and range of motion have been demonstrated. This can delay arthroplasty, which is of particular importance for younger patients with high functional demands.
authors.affiliation: Steadman Philippon Research Institute, 181 West Meadow Drive, suite 1000 Vail, CO, 81657, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Greenspoon
authors.affiliation: Steadman Philippon Research Institute, 181 West Meadow Drive, suite 1000 Vail, CO, 81657, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Millett
authors.affiliation: The Steadman Clinic, 181 West Meadow Drive Vail, CO, 81657, USA.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Moulton
authors.affiliation: Steadman Philippon Research Institute, 181 West Meadow Drive, suite 1000 Vail, CO, 81657, USA.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Petri
keywords: Irreparable rotator cuff tear; Latissimus dorsi tendon transfer; Massive rotator cuff tear; Pectoralis major tendon transfer; Rotator cuff tear; Tendon transfer