Tendon Transfers

An Overview of Tendon Transfers for Irreparable Rotator Cuff Tears

Tendon transfers are reconstructive shoulder procedures that are used as salvage procedures for the treatment of chronic irreparable rotator cuff tears (Figure 1) .

There are a variety of types of tendons transfers. Usually tendon transfers are salvage procedures which help decrease pain and improve function. Dr. Peter Millett specializes in this form of shoulder surgery and is available to discuss the treatment.

Rotator Cuff Tears

A rotator cuff tear may become irreparable for a number of reasons. In some cases, a delay in treatment may result in a rotator cuff tear that is irreparable. In other cases, an irreparable tear may result after a prior surgery where the tendon fails to heal or there is a new injury which further damages the tendon to a state that is beyond repair.

A massive rotator cuff tear is characterized as a tear that includes at least two of the four rotator cuff muscle-tendon units. While many massive rotator cuff tears can be repaired, some tears are irreparable and the tendons can no longer be attached to the original attachment sites on the humerus.

What is a Tendon Transfer?

During a tendon transfer, a working tendon and its muscle are moved from one location to another to substitute or replace the damaged or deficient muscle tendon unit. This procedure is completed so that lost function of the shoulder can be regained.

Tendon transfer surgery for an irreparable rotator cuff tear can only be performed on patients who meet the following criteria:

The patient must be physically healthy and active with functional loss of strength related to muscle loss.
The shoulder joint must be relatively healthy and flexible without signs of osteoarthritis or other evidence of degeneration.
The patient must have healthy, strong bones.
The muscles and tendons to be transferred must be healthy with normal bulk and function.
Patients must understand that there is a prolonged rehabilitation period for a tendon transfer. Since this is typically a salvage procedure, the recovery is slower. Moreover since the transferred muscle-tendon unit needs to learn a new function, a strict rehab program will need to be administered and followed carefully.

Tendon Transfers for Rotator Cuff Tears

Latissimus Dorsi Tendon Transfer

A transfer of the latissimus dorsi tendon (Figure 2) is utilized in cases of posterosuperior irreparable rotator cuff tears involving the supraspinatus and infraspinatus tendons. The functioning latissimus dorsi tendon takes on the roles of the irreparable infraspinatus and supraspinatus tendons.

Lattissimus Dorsi Tendon Transfer Video

Pectoralis Major Tendon Transfer

A transfer of the pectoralis major tendon (Figure 3) is utilized in cases of anterosuperior irreparable rotator cuff tears involving primarily the subscapularis and supraspinatus tendons. The functioning pectoralis major muscle tendon takes on the roles of the irreparable supraspinatus and subscapularis tendons.

Tendon Transfer Images

Figure 1: Arthroscopic pictures of right shoulders through the lateral portal demonstrating two types of massive rotator cuff tears. (A) Massive posterosuperior rotator cuff tear. (B) Massive anterosuperior rotator cuff tear. G = glenoid, HH = humeral head, RC = rotator cuff.

Figure 2: Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tear.
Source: http://medilink.us/4p1s

Figure 3: Pectoralis major tendon transfer for irreparable anterosuperior rotator cuff tear.
Source: http://medilink.us/dcnw

Figure 4: Combined pectoralis major and teres minor tendon transfer for irreparable anterosuperior rotator cuff tear.
Source: http://medilink.us/kbvy

Are you a candidate for a tendon transfer?

There are two ways to initiate a consultation with Dr. Millett:

You can provide current X-rays and/or MRIs for a clinical case review ($250).

You can schedule an office consultation with Dr. Millett.

Request Case Review or Office Consultation

Combined Pectoralis Major and Teres Major Tendon Transfer

In certain cases of irreparable anterosuperior rotator cuff tear, a combined transfer of the pectoralis major tendon and teres major tendon may be performed (Figure 4). The goal of this procedure is to better approximate the function of the subscapularis muscle.

Trapezius Tendon Transfer

In certain patients with irreparable posterosuperior rotator cuff tear, the lower trapezius tendon transfer may provide a more direct line of pull that improves external rotation. Compared to latissimus dorsi tendon transfers, this may do a better job of reproducing the roles of the supraspinatus and infraspinatus tendons. Though it is not an extremely common procedure, the lower trapezius tendon transfer may be a viable alternative option for patients with irreparable posterosuperior rotator cuff tears.

For additional information on tendon transfers for a failed rotator cuff repair or a winged scapula, please contact the office of Dr. Peter Millett.

What is a Rotator Cuff Tear and What are the Symptoms?

My Rotator Cuff Surgery Failed. Can You Help?

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!