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TENDON TRANSFER FOR A ROTATOR CUFF TEAR

Method
Transfer of a neighbouring muscle-tendon unit to restore the function of the shoulder
Duration
90 to 120 minutes
Recovery time
4 to 6 months

A tendon transfer is a surgical procedure for restoring the function of the shoulder where a tendon rupture – usually of the rotator cuff – cannot be repaired. A neighbouring tendon (for instance the latissimus dorsi or the lower trapezius) is redirected and fixed at a new attachment point in order to replace the movement that has been lost.

The aim is to relieve pain, improve the movement of the shoulder and make active lifting and turning of the arm possible again. The procedure is demanding and planned individually, for young, active patients or as an alternative to a shoulder replacement.

What is a tendon transfer at the shoulder?

Indications for a tendon transfer

  • An irreparable tear of the rotator cuff
  • Pseudoparalysis – being unable to lift the arm actively
  • No advanced osteoarthritis in the glenohumeral joint
  • Good muscle quality of the tendon being transferred

Common tendon transfers

  • Latissimus dorsi transfer: for posterosuperior defects (for instance of the infraspinatus)
  • Lower trapezius transfer: anatomically more favourable where external rotation is deficient
  • Pectoralis major transfer: where the subscapularis tendon has failed (internal rotation)

How the operation proceeds

  • Operation under general anaesthetic, often lying on the side
  • Mobilisation of the donor tendon
  • Creation of a tunnel, or direct transfer to the new attachment point
  • Fixation to the bone with suture anchors or sutures
  • Additional tenotomy of the long head of the biceps where appropriate

Rehabilitation after a tendon transfer

Phase I (0-6 weeks): protection and passive mobilisation
  • Wearing an abduction orthosis round the clock
  • No active movement of the shoulder
  • Passive mobilisation exercises by the physiotherapist
  • Cooling, painkillers, thrombosis prophylaxis
Phase II (7-12 weeks): active mobilisation
  • Beginning active movement without resistance
  • Avoiding the painful end range
  • Continuing mobilisation under physiotherapy guidance
  • Beginning isometric strengthening
Phase III (from week 13): building up function
  • Increasing the load in everyday life and at work
  • Targeted training of the transferred muscle group
  • Sport-specific exercises from month 5-6
  • Full loading after about 6 months