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Complications in Tendon Transfers

  • Daniel HendersonEmail author
  • Simon Boyle
Chapter

Abstract

Tendon transfers are a longstanding treatment modality for patients with irreparable rotator cuff tears. Traditionally these have been open procedures, with good medium and longer-term follow-up, but more recently numerous arthroscopic assisted and all-arthroscopic procedures have been described, with promising early results.

One of the most important factors in successful outcomes from tendon transfer procedures around the shoulder is the selection of appropriate patients, with better outcomes being reported in patients undergoing primary procedures in the absence of joint stiffness, deltoid insufficiency or pre-existing nerve injury. Such surgery should aim to recreate a functional antero-posterior force-couple in the rotator cuff, to restore glenohumeral function. Likewise, selection of appropriate donor tendons for transfer is also vital, with current evidence suggesting that Latissimus dorsi and lower trapezius tendon transfers are the most promising for addressing postero-superior cuff-tears, and latissimus dorsi for subscapularis deficiency.

Intra- and post-operative complications in this complex group of procedures are similar to those seen in all complex arthroscopic shoulder procedures. This includes a significant potential for nerve injury given the extensive soft-tissue dissection required, but also complications associated with both early and late failure of graft attachment and healing. Avoidance of the first of these complications, as with much of shoulder arthroscopy, requires detailed understanding and knowledge of the anatomy of the anterior and posterior compartments of the shoulder, while the latter group of complications is best mitigated through careful use of post-operative immobilisation and rehabilitation protocols.

Keywords

Tendon transfer Shoulder arthroscopy Complications Irreparable cuff tear 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Leeds Teaching Hospitals NHS Trust, The University of Leeds, & NIHR Leeds Biomedical Research Centre (BRC)LeedsUK
  2. 2.York Teaching Hospitals NHS TrustYorkUK

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