Evaluating tendon transfers in irreparable rotator cuff tears: A systematic review of clinical outcomes and failure rates.

Background: Irreparable rotator cuff tears (IRCTs) pose a clinical challenge, particularly in younger patients. Tendon transfers (TTs) have emerged as a joint-preserving surgical option. However, the clinical outcomes, failure rates, and complication profiles associated with different TTs remain incompletely defined. This systematic review evaluates outcomes across various TT techniques used to manage IRCTs. Methods: A systematic search of MEDLINE, Embase, and Emcare databases was conducted for studies involving adults with diagnosed IRCTs reporting patient-reported outcomes and failure rates following TT. Non-English studies, conference abstracts, case reports, and studies with <12 months follow-up were excluded. Descriptive summaries and pooled analyses were performed by tendon type. Results: Thirty studies (980 patients, 994 shoulders) were included. The mean patient age was 58.9 years, with a mean follow-up of 44.7 months. Latissimus dorsi (LD) transfers were most commonly reported. All tendon types showed significant improvements in patient-reported outcomes. Teres major transfers exhibited the highest Constant-Murley Score improvement (+40) and greatest pain reduction (VAS-5.6), although based on a single study. Failure rates ranged from 4.2% to 14.1%. Conclusions: TTs improve pain and function in IRCTs. LD transfers remain the most widely used. Variability in techniques and outcomes highlights the need for standardized protocols and further high-quality research.