Tendon Transfer for Severe Rotator Cuff Tears

Tendon transfer surgery is primarily used to treat massive irreparable rotator cuff tears. These tears often develop slowly over time due to degeneration, chronic wear and tear, previous injuries, or failed prior surgeries.

The procedure may be considered when patients experience:

• Severe weakness lifting the arm
• Difficulty rotating the shoulder outward
• Loss of overhead function
• Persistent pain
• Shoulder instability
• Failure of previous rotator cuff repair surgery

Many patients notice they can no longer perform simple daily activities such as reaching overhead, washing their hair, lifting objects away from the body, or putting on clothing.

Not every patient with a rotator cuff tear is a candidate for tendon transfer surgery. Patients with severe arthritis, major nerve injury, profound muscle wasting, or inability to move the shoulder at all may require other procedures such as reverse shoulder replacement.

Surgeons typically evaluate several factors before recommending tendon transfer, including:

• Age and activity level
• Degree of tendon damage
• Muscle quality
• Presence of arthritis
• Shoulder stability
• Previous surgeries
• Overall health

Imaging studies such as MRI and X-rays are important in determining whether the tear is repairable and whether tendon transfer is appropriate.

Tendon transfer surgery is usually performed under general anesthesia with a regional nerve block to help control pain after surgery. The procedure can be performed through open surgery, arthroscopic-assisted techniques, or a combination of both depending on the specific tendon transfer being performed.

Surgical steps:

1. The surgery begins with evaluation of the damaged rotator cuff and shoulder joint. Dr. Waterman confirms that the torn tendon cannot be repaired directly.
2. A healthy tendon with a similar function is then identified and carefully released from its original attachment while preserving its blood supply and muscle function.
3. The tendon is mobilized and transferred to a new position around the shoulder. The transferred tendon is then attached to the bone using sutures, anchors, or other fixation devices. The goal is to recreate the force and movement normally provided by the damaged rotator cuff tendon.
4. In some cases, a tendon graft may also be used to extend the transferred tendon and improve fixation.
5. Waterman then tests the shoulder to ensure the transferred tendon moves properly and provides improved stability.

The procedure generally takes several hours depending on the complexity of the tear, the type of tendon transfer, and whether additional procedures are performed at the same time. Most patients go home the same day, although some may stay overnight for observation and pain management.

Many patients experience meaningful improvement in pain, arm function, shoulder stability, and quality of life after tendon transfer surgery. While the shoulder may not return completely to normal, the procedure can significantly improve function and help patients return to many daily activities that were previously difficult or impossible.