Latissimus dorsi and teres major transfer in reverse shoulder arthroplasty: A systematic review

Background: This paper aims to conduct a systematic review of the current literature to evaluate the clinical outcomes of concurrent latissimus dorsi and teres major (LD/TM) tendon transfer in reverse shoulder arthroplasty (RSA), and to compare that to isolated RSA. Methods: A comprehensive search on PubMeb, Web of Science, Embase and CINAHL was performed from inception up to January 20, 2023, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Cohort studies, case-control studies, randomized controlled trials and case series that were written in English, which involved patients who underwent RSA with LD/TM transfer were included. Quality of studies was appraised using the Cochrane Risk Of Bias In Nonrandomized Studies of Interventions tool. Systematic review of Constant-Murley Score (CMS) and range of movement (ROM) was conducted. Results: Eight studies with a total of 265 patients were included. The average mean follow-up time was 42.5 months, with a range of 6 months to 136 months. Of the studies that reported outcomes of RSA with LD/TM transfer, five reported the CMS, five reported external rotation (ER) ROM and six reported forward flexion ROM. Comparing postoperative to preoperative scores, there was an improvement above the minimal clinically important difference for CMS (mean difference (MD) range = 22.40 to 41.80), ER (MD range = 29° to 36°) and forward flexion (MD range = 50° to 75°). Three studies that compared postoperative ER between RSA with and without LD/TM reported no significant difference. Conclusion: RSA with LD/TM transfer has good clinical outcomes postoperatively, but there is insufficient comparative data to suggest that it is superior or inferior to an isolated RSA.