Massive rotator cuff tears (MRCTs) present a particular challenge due to high rates of retear that can range from 18 to 94%, failure of healing after repair, and potential for irreparability. Management of MRCTs must take into consideration the patient's characteristics, clinical examamination and expectation, number and quality of muscle tendons units involved. Conservative treatment, arthroscopic long head of the biceps tenotomy, cuff debridement, partial repair, and superior capsule reconstruction are viable solutions to treat selected patients. The goal of tendon transfers is to achieve stable kinematic by restoring rotational strength and force coupling of the shoulder joint. The ideal candidate is a young, motivated patient with small degenerative changes of the glenohumeral joint, a massive irreparable cuff tear, significant atrophy, fatty infiltration, and functional deficit. Patients with posterosuperior massive tears have impaired shoulder function with external rotation weakness and eventually lag sign If the teres minor is affected. Latissimus dorsi transfer is the most used with results lasting for long follow-up and lower Trapezius transfer is becoming a surgical option. For anterosuperior tears, there is still controversial if pectoralis major is the best option when compared to latissimus dorsi although this last has a similar vector force with the supraspinatus tendon. Complications associated with tendon transfers include neurovascular injury, infection, and rupture of the transferred tendon.

中文翻译：

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大量肩袖撕裂的肌腱转移。

大面积肩袖撕裂 (MRCT) 带来了特殊的挑战，因为再撕裂率高达 18% 至 94%，修复后无法愈合，并且可能无法修复。MRCT 的管理必须考虑患者的特征、临床检查和期望、所涉及的肌腱单位的数量和质量。保守治疗、关节镜下肱二头肌长头肌腱切开术、袖带清创、部分修复和优质囊重建是治疗特定患者的可行解决方案。肌腱转移的目标是通过恢复肩关节的旋转强度和力耦合来实现稳定的运动学。理想的候选人是年轻、积极的患者，有盂肱关节小的退行性变化、无法修复的巨大袖带撕裂、明显萎缩、脂肪浸润和功能缺陷。后上大块撕裂的患者肩部功能受损，外旋无力，如果小圆肌受到影响，最终会出现滞后征。背阔肌移植是最常用的，其结果可以长期随访，下斜方肌移植正成为一种手术选择。对于前上撕裂，与背阔肌相比，胸大肌是否是最佳选择仍然存在争议，尽管后者与冈上肌腱具有相似的矢量力。与肌腱转移相关的并发症包括神经血管损伤、感染和转移肌腱断裂。后上大块撕裂的患者肩部功能受损，外旋无力，如果小圆肌受到影响，最终会出现滞后征。背阔肌移植是最常用的，其结果可以长期随访，下斜方肌移植正成为一种手术选择。对于前上撕裂，与背阔肌相比，胸大肌是否是最佳选择仍然存在争议，尽管后者与冈上肌腱具有相似的矢量力。与肌腱转移相关的并发症包括神经血管损伤、感染和转移肌腱断裂。后上大块撕裂的患者肩部功能受损，外旋无力，如果小圆肌受到影响，最终会出现滞后征。背阔肌移植是最常用的，其结果可以长期随访，下斜方肌移植正成为一种手术选择。对于前上撕裂，与背阔肌相比，胸大肌是否是最佳选择仍然存在争议，尽管后者与冈上肌腱具有相似的矢量力。与肌腱转移相关的并发症包括神经血管损伤、感染和转移肌腱断裂。与背阔肌相比，胸大肌是否是最佳选择仍然存在争议，尽管后者与冈上肌腱具有相似的矢量力。与肌腱转移相关的并发症包括神经血管损伤、感染和转移肌腱断裂。与背阔肌相比，胸大肌是否是最佳选择仍然存在争议，尽管后者与冈上肌腱具有相似的矢量力。与肌腱转移相关的并发症包括神经血管损伤、感染和转移肌腱断裂。