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Hanson JA, Lee S, Horan MP, Rakowski DR, Millett PJ. Superior Capsular Reconstruction Versus Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears: Minimum 5-year Outcomes. Orthop J Sports Med 2023; 11:23259671231166703. [PMID: 37213659 PMCID: PMC10196541 DOI: 10.1177/23259671231166703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 05/23/2023] Open
Abstract
Background Arthroscopic superior capsular reconstruction (SCR) has been introduced as a successful alternative to latissimus dorsi tendon transfer (LDTT) for irreparable posterosuperior rotator cuff tears. Purpose To compare minimum 5-year clinical outcomes of SCR and LDTT for the treatment of irreparable posterosuperior rotator cuff tears in patients with minimal evidence of arthritis and intact or reparable subscapularis tears. Study Design Cohort study; Level of evidence, 3. Methods Patients who underwent SCR or LDTT and had undergone surgery ≥5 years earlier were included. The SCR technique used a dermal allograft customized to the defect. Surgical, demographic, and subjective data were collected prospectively and reviewed retrospectively. Patient-reported outcome (PRO) scores utilized were the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), the short version of the Disabilities of the Arm, Shoulder and Hand score (QuickDASH), 12-Item Short Form Health Survey Physical Component Summary (SF-12 PCS), and patient satisfaction. Further surgical procedures were documented, and treatment that progressed to reverse total shoulder arthroplasty (RTSA) or revision rotator cuff surgery was considered a failure. Kaplan-Meier survivorship analysis was performed. Results Thirty patients (n = 20 men; n = 10 women) with a mean follow-up of 6.3 years (range, 5-10.5 years) were included. A total of 13 patients underwent SCR and 17 patients underwent LDTT. The mean age of the SCR group was 56 years (range, 41.2-63.9 years), and the mean age of the LDTT group was 49 years (range, 34.7-57 years) (P = .006). One patient in the SCR group and 2 patients in the LDTT group progressed to RTSA. Two additional (11.8%) patients in the LDTT group had further surgery-1 had arthroscopic cuff repair and 1 had hardware removal with biopsies. The SCR group demonstrated significantly better ASES (94.1 ± 6.3 vs 72.3 ± 16.4; P = .001), SANE (85.6 ± 8 vs 48.7 ± 19.4; P = .001), QuickDASH (8.8 ± 8.7 vs 24.3 ± 16.5; P = .012), and SF-12 PCS (56.1 ± 2.3 vs 46.5 ± 6; P = .001) PROs at the final follow-up. There was no significant difference between groups in median satisfaction (SCR, 9; LDTT, 8 [P = .379]). At 5 years, survivorship rates were 91.7% and 81.3% for the SCR and LDTT groups, respectively (P = .421). Conclusion At the final follow-up, SCR yielded superior PROs compared with LDTT for the treatment of massive, irreparable posterosuperior rotator cuff tears despite similar patient satisfaction and survivorship between procedures.
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Affiliation(s)
| | - Simon Lee
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- Northwestern Medicine, Chicago,
Illinois, USA
| | | | | | - Peter J. Millett
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado,
USA
- Peter J. Millett, MD, MSc,
Steadman Philippon Research Institute and The Steadman Clinic, 181 West Meadow
Drive, Suite 400, Vail, CO 81657, USA (
) (Twitter: @millettmd)
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Mercurio M, Castricini R, Castioni D, Cofano E, Familiari F, Gasparini G, Galasso O. Better functional outcomes and a lower infection rate can be expected after superior capsular reconstruction in comparison with latissimus dorsi tendon transfer for massive, irreparable posterosuperior rotator cuff tears: a systematic review. J Shoulder Elbow Surg 2023; 32:892-906. [PMID: 36528222 DOI: 10.1016/j.jse.2022.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/25/2022] [Accepted: 11/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Massive, irreparable rotator cuff tears, if left untreated, may result in cuff tear arthropathy, which causes shoulder disability and pain. The primary outcome of this systematic review was to evaluate differences in functional outcomes between the arthroscopic superior capsular reconstruction (SCR) and latissimus dorsi tendon transfer (LDTT) for the treatment of massive, irreparable posterosuperior rotator cuff tears without arthritis. The secondary outcome was to compare complication and reoperation rates between the 2 surgical procedures. METHODS The PubMed, MEDLINE, Scopus, and Cochrane Central databases were searched using keywords, and 20 studies were included in this review. Data extracted for quantitative analysis included the American Shoulder and Elbow Surgeons score, the Constant-Murley score, the subjective shoulder value, the range of motion, the visual analog scale for pain, numbers and types of complications, and reoperation rate. The preoperative fatty degeneration of the muscles and the preoperative and follow-up acromiohumeral distance and glenohumeral osteoarthritis according to the Hamada grading system were also reported. RESULTS A total of 1112 patients were identified, among whom 407 and 399 underwent SCR and LDTT, respectively. The SCR group showed a higher mean age at the time of operation (64.5 ± 7.8 vs. 62.1 ± 8.9 years; P < .001). The SCR group showed a lower rate of previous surgical procedures on the shoulder (35 out of 407 vs. 111 out of 399; P < .001) and a shorter mean follow-up (30.4 ± 7.5 vs. 36.3 ± 10.3 months; P < .001). Patients who underwent SCR reported significantly better functionality and residual pain as measured by the Constant-Murley score (75.5 ± 11.2 vs. 65.6 ± 22.8, P < .001), the American Shoulder and Elbow Surgeons score (84.3 ± 13 vs. 67.7 ± 23, P < .001), the subjective shoulder value (79.4 ± 13 vs. 64.4 ± 23, P < .001), and the visual analog scale (1.4 ± 2 vs. 2.8 ± 3, P < .001) than patients who underwent LDTT. A greater acromiohumeral distance (5.8 ± 2.5 vs. 7.6 ± 2.7, P < .001) was found in the SCR group. The SCR group showed a significantly lower infection rate (0.2% vs. 2.8%., P = .003) and a higher graft failure rate (12.3% vs. 6.8%, P = .012). No differences in terms of reoperation for graft failure (1% vs. 2.3% for SCR and LDTT, respectively; P = .172) or for conversion to reverse total shoulder arthroplasty (1.7% vs. 2% for SCR and LDTT, respectively; P = .800) were found. CONCLUSION Patients undergoing SCR report better functional outcomes and greater acromiohumeral distance than those undergoing LDTT. The LDTT group shows a significantly higher infection rate, while the SCR group shows a significantly higher graft failure rate, but there are no differences in terms of reoperation between the 2 surgical procedures.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, "Villa Verde" Hospital, Fermo, Italy; Department of Orthopaedic and Trauma Surgery, "Villa Maria Cecilia" Hospital, Cotignola, Italy
| | - Davide Castioni
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy; Department of Orthopedic and Trauma Surgery, Girolamo Fracastoro Hospital, Verona, Italy
| | - Erminia Cofano
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy.
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
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Abstract
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.
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Affiliation(s)
- Antonio Cartucho
- Shoulder and Elbow Unit, Hospital Cuf Descobertas, Lisbon, Portugal
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Waltenspül M, Jochum B, Filli L, Ernstbrunner L, Wieser K, Meyer D, Gerber C. Mid-term results of arthroscopically assisted latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears. J Shoulder Elbow Surg 2021; 30:e676-e688. [PMID: 33878485 DOI: 10.1016/j.jse.2021.03.149] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/21/2021] [Accepted: 03/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND With progress in arthroscopic surgery, latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears (RCTs) has become a reliable all-arthroscopic or arthroscopically assisted procedure. The mid-term results of arthroscopically assisted latissimus dorsi transfer (aLDT) are scarce in the literature. The purpose of this study was to report our clinical and radiographic mid-term results of aLDT for irreparable posterosuperior RCTs. METHODS Thirty-one consecutive patients with a mean age of 55.5 years (range, 38-73 years) at the time of aLDT were evaluated after a mean of 3.5 years (range, 2-5 years). All patients had irreparable, full-thickness tears of at least the complete supraspinatus, with or without infraspinatus tendons, and 12 patients (39%) had undergone previous rotator cuff repair (RCR). A concomitant upper-third subscapularis repair was needed at the time of aLDT in 7 patients (23%). Mid-term results were assessed clinically and radiographically (including magnetic resonance imaging). RESULTS At final follow-up, 4 patients with failure (13%) had undergone revision to reverse total shoulder arthroplasty (RTSA) essentially for untreatable pain. Patients with revision to RTSA had significantly higher preoperative pain levels (Constant pain score, 6 points vs. 11 points; P = .032) and lower Constant activity scores (2 points vs. 5 points, P = .017) than the remaining 27 patients. Patients with failed previous RCRs had significantly inferior results compared with patients without previous repair (mean Subjective Shoulder Value, 67% vs. 88%; P = .035). For the 27 patients without revision, the mean relative Constant score improved from 63% to 76% (P = .032), the Constant pain score, from 10.5 to 12.7 points (P = .012), and the Subjective Shoulder Value, from 43% to 77% (P < .001). Significant progression of glenohumeral arthropathy by 2 or more grades according to the Hamada classification was observed in 13 of the 27 patients (48%), but there was no significant difference in clinical outcomes between the patients with arthropathy (n = 13) and those without it (n = 14, P = .923). CONCLUSIONS The mid-term results of aLDT for irreparable posterosuperior RCTs were associated with significant improvements in objective and subjective outcome measures. The failure rate leading to conversion to RTSA was relatively high in this cohort. The failures were associated with unusually intense pain in low-demand individuals and/or revision of failed RCR. Long-term results of aLDT are needed to evaluate the effect of this procedure on the progression of osteoarthritis.
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Affiliation(s)
- Manuel Waltenspül
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| | - Benedikt Jochum
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lukas Filli
- Department of Radiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Dominik Meyer
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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IPPOLITO G, CASTIGLIA SF, SERRAO M, CONTE C, RICCIARDI L, FERRARO S, DI LENOLA D, SURACE MF, DE MARINIS G. Effects of latissimus dorsi tendon transfer on shoulder motion and muscle activation: a follow-up observational study. MINERVA ORTHOPEDICS 2021; 72. [DOI: 10.23736/s2784-8469.21.04119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2025]
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Kucirek NK, Hung NJ, Wong SE. Treatment Options for Massive Irreparable Rotator Cuff Tears. Curr Rev Musculoskelet Med 2021; 14:304-315. [PMID: 34581991 PMCID: PMC8497660 DOI: 10.1007/s12178-021-09714-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Massive irreparable rotator cuff tears present a significant challenge to the orthopedic surgeon. No single treatment, particularly among joint-preserving options, has been shown to be superior. The purpose of this review is to discuss recent advances in the treatment of massive irreparable rotator cuff tears, including partial repair with and without graft augmentation, interposition grafts, superior capsule reconstruction, subacromial balloon spacers, tendon transfer, and reverse total shoulder arthroplasty. We will also offer guidance on surgical indications based on our clinical experience. RECENT FINDINGS Partial repair may offer reasonable clinical improvement for patients with lower preoperative function despite high re-tear rates. Additionally, several types of interposition grafts have shown promising short-term results and may outperform repair alone. Subacromial balloon spacers may lead to clinical improvement, especially in patients without glenohumeral osteoarthritis or pseudoparalysis, and recently received FDA approval for use in the USA. Superior capsule reconstruction is a technically demanding procedure that appears to produce excellent short-term results particularly when performed at high volume, but long-term studies in heterogeneous study groups are needed. Tendon transfers improve function by restoring force coupling in the shoulder, offering a promising option for younger patients. Reverse total shoulder arthroplasty (RTSA) is a reliable option for treatment of irreparable cuff tears in elderly patients with lower functional demands. Irreparable cuff tears remain a difficult condition to treat. Recommended treatment for younger patients without glenohumeral osteoarthritis is particularly controversial. For older patients with low-demand lifestyles and glenohumeral osteoarthritis, RTSA is an effective treatment option. For all discussed procedures, patient selection appears to play a critical role in clinical outcomes.
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Affiliation(s)
- Natalie K. Kucirek
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Nicole J. Hung
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Stephanie E. Wong
- Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens Street, San Francisco, CA 94158 USA
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Ozturk BY, Ak S, Gultekin O, Baykus A, Kulduk A. Prospective, randomized evaluation of latissimus dorsi transfer and superior capsular reconstruction in massive, irreparable rotator cuff tears. J Shoulder Elbow Surg 2021; 30:1561-1571. [PMID: 33675971 DOI: 10.1016/j.jse.2021.01.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of massive, irreparable rotator cuff tears remains controversial today because there is no consensus on the ideal treatment option. This investigation aimed to prospectively evaluate and compare the outcomes of arthroscopy-assisted latissimus dorsi transfer and superior capsular reconstruction in the treatment of massive, irreparable rotator cuff tears. METHODS Forty-two patients at an average age of 62.8 years with massive, irreparable rotator cuff tears were randomized into 2 treatment groups. Twenty-one patients underwent arthroscopy-assisted latissimus dorsi tendon transfer (LDT), and 21 patients underwent arthroscopy-assisted superior capsular reconstruction (SCR). The patients were followed up prospectively for 31 months on average. One patient in the SCR group was lost to follow-up. The outcomes were evaluated with American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Western Ontario Rotator Cuff Index (WORC), visual analog scale (VAS), and Constant scores clinically and with acromiohumeral distance (AHD) measurements radiologically. RESULTS Both groups displayed improved results in ASES, WORC, Constant, and VAS scores in the final follow-up (P < .001). The LDT group had significantly better results in AHD (P = .006), whereas the SCR group yielded significantly higher improvements in ASES (P = .007) and Constant (P = .008) scores. The rate of successful pseudoparalysis treatment was 45% (5/11) in the LDT group and 92% (12/13) in the SCR group (P = .011). The graft failure rate was 5% (1 patient) in each group postoperatively; 1 patient in the SCR group had a traumatic graft rupture and 1 patient in the LDT group was complicated with septic arthritis, which required graft removal. CONCLUSION Both SCR and LDT yielded promising short-term results in treatment of massive, irreparable rotator cuff tears in this study. The SCR group displayed better overall outcomes clinically, particularly in the pseudoparalytic shoulders, whereas the LDT group displayed better radiologic results.
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Affiliation(s)
| | - Semih Ak
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Onur Gultekin
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Ali Baykus
- Empiar Consultation and Research, Istanbul, Turkey
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Kadow TR, Meredith SJ, Garcia D, Minorini R, Delaney R, Baratz M, Lin A. Latissimus Dorsi Tendon Transfer and Superior Capsular Reconstruction for Irreparable, Posterosuperior Rotator Cuff Tears. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:44-49. [PMID: 33778114 DOI: 10.22038/abjs.2020.50854.2527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to compare latissimus dorsi tendon transfer (LDTT) and arthroscopic superior capsular reconstruction (SCR) to determine if one is superior to the other regarding improvement in range of motion (ROM) or patient-reported outcomes (PROs). Methods A multicenter, retrospective cohort study was conducted on 43 patients with an irreparable, posterosuperior rotator cuff tear who underwent either LDTT or SCR. Preoperative and postoperative forward flexion and external rotation, as well as PROs including ASES, VAS, and SSV, were assessed. Student t-test and chi-square statistical analyses were performed. Results 16 LDTT, at mean follow-up of 18 months, and 27 SCR, at mean follow-up 15 months, were studied. Mean active forward flexion significantly improved from 85.2° to 137.6° in the SCR cohort (P=0.001). SCR patients demonstrated a significantly greater increase in forward flexion as compared to LDTT patients (52.4° vs 14.1°, P=0.001). Mean active external rotation amongst the LDTT group significantly improved from 41.7° to 61.5° (P=0.032). LDTT demonstrated significantly greater improvement in external rotation as compared to SCR (19.4° vs 0.8°, P=0.011). There were no significant differences in reported ASES, VAS, or SSV scores. Conclusion This study demonstrates successful clinical and patient-reported outcomes with both LDTT and SCR for irreparable, posterosuperior rotator cuff tears, with greater improvement in forward flexion with SCR and greater improvement in external rotation with LDTT.
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Affiliation(s)
- Tiffany R Kadow
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sean J Meredith
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | - Mark Baratz
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Albert Lin
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Turkmen I, Koraman E, Poyanlı O. Latissimus dorsi tendon transfers: a historical journey. SICOT J 2021; 7:9. [PMID: 33683194 PMCID: PMC7938722 DOI: 10.1051/sicotj/2021009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/10/2021] [Indexed: 11/15/2022] Open
Abstract
Several latissimus dorsi tendon transfer techniques for shoulder problems have been previously described and developed. These techniques involve the transfer in obstetric palsy, transfer in irreparable posterosuperior rotator cuff tears and subscapularis tears, and transfer in reverse shoulder arthroplasty. We detail the differences in planning and surgery and the need for different approaches. This historical and technical description provided in this study will benefit surgeons wishing to use the procedure.
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Affiliation(s)
- Ismail Turkmen
- Associate Professor, Department of Orthopaedics and Traumatology, Goztepe City Hospital, Egitim mh Dr. Erkin cd, 34722 Kadikoy, Istanbul, Turkey
| | - Emre Koraman
- MD, Department of Orthopaedics and Traumatology, Goztepe City Hospital, 34722 Kadikoy, Istanbul, Turkey
| | - Oguz Poyanlı
- Professor, Department of Orthopaedics and Traumatology, Goztepe City Hospital, 34722 Kadikoy, Istanbul, Turkey
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Outcome of arthroscopically assisted lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tears. J Shoulder Elbow Surg 2020; 29:2135-2142. [PMID: 32573447 DOI: 10.1016/j.jse.2020.02.018] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study is to report the outcome of arthroscopically assisted lower trapezius transfer to reconstruct irreparable posterior-superior rotator cuff tear. METHODS Forty-one consecutive patients with irreparable posterior-superior rotator cuff tears who underwent an arthroscopically assisted transfer of the lower trapezius transfer were included in this study. The patients' average age was 52 years (range 37-71), and average follow-up was 14 months (range 6-19 months). Nineteen patients had true pseudoparalysis preoperatively, whereas 66% had a prior failed rotator cuff repair. Outcome measures included visual analog scale (VAS) pain score, range of motion, Subjective Shoulder Value (SSV), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS Thirty-seven (90%) patients had significant improvement of all outcome scores: VAS, SSV, and DASH. The presence of a subscapularis tear did not affect the outcome. However, 3 patients who had preoperative rotator cuff arthropathy changes of the shoulder had persistent pain and limited range of motion of the shoulder after surgery, and 2 of them underwent reverse shoulder arthroplasty. Two additional patients had a traumatic rupture of the transfer as a result of fall (at 5 and 8 months postop). One underwent revision arthroscopic repair and did well after surgery, and the other had good pain relief but recurrent weakness and limited range of motion, and elected not to have a revision surgery. CONCLUSIONS Arthroscopic-assisted lower trapezius transfer may lead to a good outcome in patients with massive irreparable posterior-superior rotator cuff tears, including patients with pseudoparalysis. The presence of an associated reparable subscapularis tear did not affect the outcome.
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Wieser K, Ernstbrunner L, Zumstein MA. Surgical Management of Massive Irreparable Cuff Tears: Latissimus Dorsi Transfer for Posterosuperior Tears. Curr Rev Musculoskelet Med 2020; 13:605-611. [PMID: 32661917 PMCID: PMC7474718 DOI: 10.1007/s12178-020-09659-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW This review aims to describe the role of the latissimus dorsi transfer (LDT) for patients with irreparable posterosuperior rotator cuff tears (RCTs). RECENT FINDINGS Historically, the LDT has been performed as an open (double-incision) procedure for neurologically intact, relatively young patients with irreparable posterosuperior RCTs with disabling loss of active external rotation with or without impaired active elevation. The transferred tendon reconstitutes the posterior rotator cuff and force couple, respectively and thus has the potential to function effectively as an external rotator and humeral head depressor. Long-term results of the open technique have demonstrated in the majority of patients substantial and durable improvements in shoulder function and pain relief at the 10-year benchmark. With the advancements of arthroscopic surgery, the LDT was expanded to an arthroscopically assisted procedure with promising short-term results. In addition to adequate technical performance, the success of the procedure depends on preoperative factors, such as exclusion of glenohumeral osteoarthritis and acromial acetabularization; intact or reparable subscapularis tendon; intact (or hypertrophic) teres minor muscle; adequate preoperative activity of the latissimus dorsi; and normal or mild impairment of overhead function. The LDT (open or arthroscopically assisted) is a reliable treatment option for patients with massive, irreparable posterosuperior RCTs with disabling loss of active external rotation, with or without diminished overhead function and without advanced glenohumeral osteoarthritis. Precise patient selection is of tremendous importance in the success of the LDT.
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Affiliation(s)
- Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
| | - Lukas Ernstbrunner
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Matthias A Zumstein
- Shoulder, Elbow & Orthopaedic Sports Medicine, Orthopaedics Sonnenhof; Inselspital, University of Berne, Bern, Switzerland.,SportsClinicNumber1, Bern, Switzerland
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The latissimus dorsi tendon functions as an external rotator after arthroscopic-assisted transfer for massive irreparable posterosuperior rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2020; 28:2367-2376. [PMID: 31811355 DOI: 10.1007/s00167-019-05819-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/27/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Latissimus dorsi tendon transfer is a surgical option for the treatment of massive irreparable posterosuperior rotator cuff tear. Whether a favourable clinical outcome is due to the latissimus dorsi muscle contraction rather than the passive tenodesis effect remains to be confirmed. The purpose of the current case-control study was to evaluate the shoulder kinematics and latissimus dorsi activation after latissimus dorsi tendon transfer. METHODS Eighteen patients suffering from irreparable rotator cuff tear that underwent latissimus dorsi tendon transfer and 18 healthy individuals were examined using a 3D kinematic tracking system and electromyography. Active maximal flexion-extension and abduction-adduction of the humerus were measured for the operated and the contralateral shoulder of the patients and the shoulder of healthy individuals to evaluate the range of motion (ROM) and scapulohumeral rhythm. Electromyographic comparison of isometric contraction between the latissimus dorsi of the operated and contralateral shoulder was carried out. RESULTS After arthroscopic-assisted latissimus dorsi tendon transfer, patients showed comparable flexion and abduction ROM to their asymptomatic contralateral shoulders and to the shoulders of healthy individuals. Significantly higher scapular ROM values were found between the latissimus dorsi tendon transfer side and the shoulders of healthy individuals. While performing external rotation with 0° shoulder abduction, a greater percentage of the electromyographic peak value (p = 0.047) and a higher latissimus dorsi internal/external rotation ratio (p = 0.004) were noted for the transferred muscle in comparison to the contralateral shoulder. CONCLUSION Although the arthroscopic-assisted latissimus dorsi tendon transfer failed to normalize scapulothoracic joint movements of patients, a functional latissimus flap and a shoulder ROM similar to the contralateral side or the shoulder of healthy individuals can be expected after this procedure in patients with massive irreparable posterosuperior rotator cuff tear. LEVEL OF EVIDENCE III.
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Panella A, Baglioni M, Rifino F, De Crescenzo A, Notarnicola A, Moretti B. Pseudomonas aeruginosa infection of shoulder joint after latissimus dorsi tendon transfer: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20921326. [PMID: 32477563 PMCID: PMC7234343 DOI: 10.1177/2050313x20921326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 03/26/2020] [Indexed: 12/02/2022] Open
Abstract
Infection rates of arthroscopic procedures have been consistently reported at approximately 1% and are even less common in shoulder arthroscopy (0.3%). We are unaware of any prior reports of infection associated with an arthroscopic-assisted latissimus dorsi transfer and report on a 60-year-old male who experienced this event. At the 2-month follow-up, he reported an infection of the shoulder joint, characterized by a fistula on the portal scar. Laboratory tests revealed a Pseudomonas aeruginosa infection which was treated with arthroscopic irrigation and debridement of the shoulder joint followed by oral antibiotics for 6 weeks. At 1-year follow-up no findings of infection were presented. To our knowledge, this is the first case of P. aeruginosa infection of the shoulder after an arthroscopic-assisted latissimus dorsi tendon transfer. Because the empirical pharmacological therapy initially adopted did not produce a clinically important improvement, a more organism-specific antibiotic was used. In conclusion, the key points of positive results were surgical approach with careful washout, debridement of surgical accesses, and targeted antibiotic therapy.
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Affiliation(s)
- Antonio Panella
- Orthopedics Section, Department of Medical Science of Basis, Neuroscience and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Bari, Italy
| | - Marco Baglioni
- Orthopedics Section, Department of Medical Science of Basis, Neuroscience and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Bari, Italy
| | - Francesco Rifino
- Orthopedics Section, Department of Medical Science of Basis, Neuroscience and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Bari, Italy
| | - Angelo De Crescenzo
- Orthopedics Section, Department of Medical Science of Basis, Neuroscience and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Bari, Italy
| | - Angela Notarnicola
- Orthopedics Section, Department of Medical Science of Basis, Neuroscience and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Bari, Italy
| | - Biagio Moretti
- Orthopedics Section, Department of Medical Science of Basis, Neuroscience and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Bari, Italy
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Kany J, Sekaran P, Grimberg J, Amavarathi RS, Valenti P, Elhassan B, Werthel JD. Risk of latissimus dorsi tendon rupture after arthroscopic transfer for posterior superior rotator cuff tear: a comparative analysis of 3 humeral head fixation techniques. J Shoulder Elbow Surg 2020; 29:282-290. [PMID: 31473133 DOI: 10.1016/j.jse.2019.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND To compare latissimus dorsi tendon rupture rates after arthroscopic transfer for posterior superior rotator cuff tear using 3 different humeral head fixation techniques. METHODS One-hundred fifty consecutive latissimus dorsi transfers were included. Inclusion criteria were massive irreparable posterosuperior rotator cuff tear with advanced fatty infiltration associated with persistent pain and limited range of motion after failed conservative treatments or surgery. All transfers were arthroscopically assisted and fixed in a transosseous tunnel with a cortical button (group 1, n = 59), "over the top" onto the footprint of the supraspinatus (group 2, n = 47), or posteriorly onto the footprint of the infraspinatus (group 3, n = 44) with 2 suture anchors. The tendons were marked with 3 metallic clips placed intraoperatively at a fixed distance of 2, 4, and 6 cm from the tip. Immediate postoperative standard anteroposterior radiographs were performed to confirm the position of the clips and to determine whether the clips displaced on subsequent radiographs during follow-up, indicating tendon rupture. RESULTS Repeat radiographs at 3-month follow-up showed higher risk of latissimus dorsi transfer rupture rate in 27/59 patients in group 1 (46%), 11/47 in group 2 (24%), and 7/44 in group 3 (15%). CONCLUSION Posterior anchor fixation of the latissimus dorsi tendon onto the infraspinatus footprint had the lowest rupture rate.
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Affiliation(s)
- Jean Kany
- Shoulder Department, Clinique de l'Union, Ramsay GDS, Saint Jean, France.
| | | | - Jean Grimberg
- Shoulder Department, LIRCOS, Clinique Jouvenet, Ramsay GDS, Paris, France
| | - Rajkumar S Amavarathi
- Division of Arthroscopy and Sports Surgery, Department of Orthopaedics, St John's Medical College and Hospital, Bangalore, Karnataka, India
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Tendon transfers in rotator-cuff surgery. Orthop Traumatol Surg Res 2020; 106:S43-S51. [PMID: 31843509 DOI: 10.1016/j.otsr.2019.05.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 04/22/2019] [Accepted: 05/10/2019] [Indexed: 02/08/2023]
Abstract
Indications and techniques for tendon transfer in irreparable rotator-cuff tear have greatly progressed and are no longer restricted to external rotation deficit. The present article first reviews the various types of tear and corresponding tendon transfers and the biomechanics of the pseudoparalytic shoulder. The indication of choice for tendon transfer is iterative tear following failure of isolated long biceps tenotomy or partial repair. Latissimus dorsi, inferior trapezius and pectoralis major transfer are the 3 types to be used after failure of primary surgery. Latissimus dorsi transfer is indicated for partial loss of active limb elevation or isolated loss of internal rotation. Inferior trapezius transfer is best indicated for isolated active external rotation deficit. In pseudoparalytic shoulder with total loss of active elevation or combined loss of elevation and active external rotation, isolated transfer is insufficiently powerful to restore active range of motion and should be associated to reverse arthroplasty. We describe the various transfer techniques and report their results.
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Woodmass JM, Wagner ER, Chang MJ, Welp KM, Elhassan BT, Higgins LD, Warner JJP. Arthroscopic Treatment of Massive Posterosuperior Rotator Cuff Tears: A Critical Analysis Review. JBJS Rev 2019; 6:e3. [PMID: 30204644 DOI: 10.2106/jbjs.rvw.17.00199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jarret M Woodmass
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric R Wagner
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Michelle J Chang
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathryn M Welp
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Jon J P Warner
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
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Osti L, Buda M, Andreotti M, Gerace E, Osti R, Massari L, Maffulli N. Arthroscopic-assisted latissimus dorsi transfer for massive rotator cuff tear: a systematic review. Br Med Bull 2018; 128:23-35. [PMID: 30137207 DOI: 10.1093/bmb/ldy030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/28/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION This systematic review provides a comprehensive description of different surgical techniques for massive rotator cuff tears (MRCTs) using arthroscopic-assisted latissimus dorsi transfer (A-LDT), reporting clinical outcomes and complications. SOURCES OF DATA We searched the literature on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'latissimus dorsi', 'tendon', 'transfer', 'rotator cuff tears', 'shoulder' and 'arthroscopy' to identify articles published in English, Spanish, French and Italian. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed for the manuscript selection. AREAS OF AGREEMENT Ten studies (five retrospective and five prospective investigations), all published between 2014 and 2018, fulfilled our inclusion criteria, dealing with 348 (55.7% male) patients, with a mean age of 61.6 years (range 31-83). AREAS OF CONTROVERSY A-LDT is a technical demanding procedure. When compared with the open technique, it does not seem to provide significant subjective and objective clinical outcome improvements. GROWING POINTS A-LDT seems to yield lesser surgical complications and post-operative stiffness. Sparing the deltoid muscle belly could result in a more effective shoulder post-surgery function. AREAS TIMELY FOR DEVELOPING RESEARCH Further comparative randomized controlled trials with longer follow-up are needed to clarify the potentially promising superiority of A-LDT.
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Affiliation(s)
- Leonardi Osti
- Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Via Arqua', Modena, Italy
| | - Matteo Buda
- Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Via Arqua', Modena, Italy
| | - Mattia Andreotti
- Department of Trauma and Orthopaedic Surgery, University of Ferrara, S.Anna Hospital, Via Aldo Moro, Ferrara, Italy
| | - Emanuele Gerace
- Department of Trauma and Orthopaedic Surgery, University of Ferrara, S.Anna Hospital, Via Aldo Moro, Ferrara, Italy
| | - Raffaella Osti
- Department of Trauma and Orthopaedic Surgery, University of Ferrara, S.Anna Hospital, Via Aldo Moro, Ferrara, Italy
| | - Leo Massari
- Department of Trauma and Orthopaedic Surgery, University of Ferrara, S.Anna Hospital, Via Aldo Moro, Ferrara, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno, Italy.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke on Trent, UK.,Centre for Sport and Exercise Medicine, Queen Mary University of London, London, UK
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Comparison of arthroscopically assisted transfer of the latissimus dorsi with or without partial cuff repair for irreparable postero-superior rotator cuff tear. INTERNATIONAL ORTHOPAEDICS 2018; 43:387-394. [PMID: 29948013 DOI: 10.1007/s00264-018-4016-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of an additional partial repair in combination with an arthroscopically assisted transfer of the latissimus dorsi (LDT) in massive postero-superior irreparable cuff tear. MATERIALS AND METHODS Thirty-one patients (mean age 59.2 years) scheduled for arthroscopically assisted LDT either isolated or in combination with a partial cuff repair for a massive posterior-superior cuff tear were prospectively included between January 2011 and December 2013 at our institution. Seventeen had an isolated transfer (Group A) and 14 had a transfer combined with a partial cuff repair (Group B). Outcome measures included visual analogue scale (VAS), range of motion, strength, constant score, and subjective shoulder value (SSV). Potential predictive factors were analyzed. RESULTS At the last follow-up (mean 22 months), patients in Group B had a significantly higher constant score (64 ± 8 versus 58 ± 4 in Group A), range of motion (33 ± 5 versus 29 ± 5 points in Group A), and strength at 90° of abduction (2.5 kg ± 1 in Group B versus 1.9 kg ± 0.9 in Group A). No significant differences were found between both groups regarding pain scores, SSV, and active external rotation. Thirty-seven variables were analyzed and the only factor which was found to be predictive of a bad result was a preoperative SSV < 40 pts. (RR 0.5). CONCLUSION Arthroscopically assisted LDT gives better results when combined with a partial repair of the cuff than when it is performed isolated in the treatment of massive irreparable postero-superior rotator cuff tear. LEVEL OF EVIDENCE Treatment study, Level II.
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Memon M, Kay J, Quick E, Simunovic N, Duong A, Henry P, Ayeni OR. Arthroscopic-Assisted Latissimus Dorsi Tendon Transfer for Massive Rotator Cuff Tears: A Systematic Review. Orthop J Sports Med 2018; 6:2325967118777735. [PMID: 29942816 PMCID: PMC6009089 DOI: 10.1177/2325967118777735] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Arthroscopic-assisted latissimus dorsi tendon transfer (LDTT) has shown promising results with good outcomes in patients with massive rotator cuff tears (MRCTs), as reported by individual studies. However, to the best of the authors’ knowledge, no systematic review has been performed to assess the collective outcomes of these individual studies. Purpose/Hypothesis: The primary purpose of this study was to assess patient outcomes after arthroscopic-assisted LDTT for the management of MRCTs. The secondary objectives were to report on the management of MRCTs, including diagnostic investigations, surgical decision making, and arthroscopic techniques, as well as to evaluate the quality of evidence of the existing literature. It was hypothesized that nearly all patients were satisfied with arthroscopic-assisted LDTT and that they experienced improvements in pain symptoms, function, and strength after the procedure, with an overall complication rate of less than 10%. Study Design: Systematic review; Level of evidence, 4. Methods: The databases MEDLINE, Embase, and PubMed were searched from database inception (1946) until August 18, 2017, with titles, abstracts, and full-text articles screened independently by 2 reviewers. Inclusion criteria were English-language studies investigating arthroscopic-assisted LDTT for the management of MRCTs on patients of all ages. Conference papers, book chapters, review articles, and technical reports were excluded. The quality of the included studies was categorized by level of evidence and the Methodological Index for Non-Randomized Studies (MINORS) checklist. Results: In total, 8 studies (7 case series [median MINORS score, 7 of 16] and 1 prospective comparative study [median MINORS score, 14 of 24]) were identified; the studies included 258 patients (258 shoulders) with MRCTs treated with LDTT using arthroscopic-assisted techniques. The decision to pursue surgery was based on both clinical findings and investigations in 5 studies, investigations only in 2 studies, and clinical findings only in 1 study. Overall, 88% of patients were satisfied with the results of surgery and experienced significant improvement in their symptoms, including shoulder pain, strength, range of motion, and overall function, over a mean follow-up period of 34.3 months. Overall, there was a low rate of complications (7%) associated with the procedure. Conclusion: Arthroscopic-assisted LDTT for MRCTs provides patients with marked improvement in shoulder pain, strength, and function, and the procedure is associated with a low risk of complication. Further high-quality comparative studies are warranted to validate these findings in comparison with other operative techniques.
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Affiliation(s)
- Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Emily Quick
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Henry
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Kany J, Grimberg J, Amaravathi RS, Sekaran P, Scorpie D, Werthel JD. Arthroscopically-Assisted Latissimus Dorsi Transfer for Irreparable Rotator Cuff Insufficiency: Modes of Failure and Clinical Correlation. Arthroscopy 2018; 34:1139-1150. [PMID: 29361422 DOI: 10.1016/j.arthro.2017.10.052] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/17/2017] [Accepted: 10/21/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The main objective of this retrospective study was to analyze the rate and modes of failure of latissimus dorsi transfer (LDT). The secondary objective was to evaluate whether a rupture of the transfer was associated with a worse outcome. METHODS During a 2-year period, we performed consecutive LDTs either for irreparable posterior-superior rotator cuff tears (RCTs) or for failed prior repair. All the LDTs were performed by a single surgeon. All transfers were arthroscopically assisted and fixed as a tubularized LD tendon in a bone tunnel inside the humeral head. Three metal clips were placed systematically intraoperatively in the tubularized tendon at a fixed distance of 2, 4, and 6 cm from the tip of the tendon. Immediate postoperative standard anteroposterior radiographs were performed and the position of the metal clips was compared with their position on radiographs performed at 6 weeks and 3 and 24 months postoperatively. Constant, Subjective Shoulder Value (SSV), Simple Shoulder Test (SST), Activities of daily living requiring active external rotation (ADLER), visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) scores and patient's subjective satisfaction (assessed by self-questionnaire) at last follow-up were compared between patients who had a rupture of the transfer and those who did not. RESULTS Sixty-six patients were included. Six of 66 patients (9%) were lost to follow-up. There were 11 complications (18.3%) in the global series (10 hematoma and 1 subscapularis retear). At a mean 35.2 months (range 24-50 months), there were 23/60 cases of rupture (38%). The 7 scores and the satisfaction reported were significantly lower for patients who had a rupture of the transfer versus those who had an intact transfer: Constant score, 42.8 versus 68.7 (P = .001); SSV, 48.9 versus 71.6 (P = .001); SST, 4.8 versus 8.4 (P = .012); ADLER, 19.7 versus 26.7 (P = .005); VAS, 3.7 versus 2.3 (P = .082); ASES, 55.4 versus 74.8 (P = .056); and 13% of either satisfied or very satisfied patients versus 78% (P < .001). CONCLUSIONS The rate of rupture of LDT is high (38%). With complete healing of LDT, the outcome is significantly lower in those with rupture compared with those without rupture, showing that LDT can efficiently treat massive and irreparable RCT. LEVEL OF EVIDENCE Level IV, case series treatment study.
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Affiliation(s)
- Jean Kany
- Clinique de l'Union, Saint Jean, France.
| | | | - Rajkumar S Amaravathi
- Department of Orthopedics, Arthroscopy and Sports Medicine, St John's Medical College Hospital, Bangalore, India
| | - Padmanaban Sekaran
- Department of Physiotherapy and Rehabilitation, Sparsh Hospital for Advanced Surgeries, Bangalore, India
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Abstract
PURPOSE OF REVIEW This review aims to describe the tendon transfer options for treating irreparable rotator cuff tears (RCTs). Options for transfer include latissimus dorsi and lower trapezius transfers for posterior-superior RCTs and pectoralis major and latissimus dorsi transfer for anterior-superior RCTs. RECENT FINDINGS While the latissimus dorsi tendon transfer has historically been performed for posterosuperior RCTs, the lower trapezius transfer is a more anatomic option and has demonstrated promising results in recent studies. Similarly, the pectoralis major transfer has historically been the tendon transfer of choice for anterosuperior RCTs. However, the latissimus dorsi tendon transfer has recently been shown to be a safe and anatomic tendon transfer for subscapularis insufficiency. The treatment of irreparable RCTs involves complex decision making. Tendon transfer procedures can restore the glenohumeral joint force couples, allowing restoration of near-normal shoulder kinematics. Benefits include reliable pain relief, increased function, and increased strength. Proper selection of donor tendon is crucial, and the principles of tendon transfer procedures must be adhered to for maximal benefit.
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Yamakado K. Clinical and Radiographic Outcomes With Assessment of the Learning Curve in Arthroscopically Assisted Latissimus Dorsi Tendon Transfer for Irreparable Posterosuperior Rotator Cuff Tears. Arthroscopy 2017; 33:2144-2151. [PMID: 28822641 DOI: 10.1016/j.arthro.2017.06.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/26/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical results of an arthroscopy-assisted latissimus dorsi tendon transfer (aLD) for irreparable posterosuperior cuff tears as a primary surgery. The secondary aim of this study was to quantify the learning curve using the log-linear model. We hypothesized that aLD significantly improved shoulder function and that there was consistent reduction of the operative time in support of a learning-curve effect. METHODS After the arthroscopic partial repair was completed, the latissimus dorsi tendon was harvested via axillary mini-open incision and fixed with a knotless anchor arthroscopically. All patients were evaluated preoperatively and postoperatively using a modified University of California Los Angeles (UCLA) scoring system, active range of motion, and the visual analog scale (VAS) for pain. The operative time was recorded to quantify the learning curve using a log-linear model. RESULTS Thirty patients with a mean age of 67.4 years who underwent aLD were included. At a mean of 34 months after an aLD, the mean UCLA score increased from 15.7 preoperatively to 28.8 postoperatively (P < .001). The mean active forward elevation increased from 105° preoperatively to 149° postoperatively (P < .001). The mean active external rotation increased from 22° preoperatively to 32° postoperatively (P < .001). The VAS improved from 58 mm to 18 mm (P < .001). In all but 2 cases (93%), the preoperative osteoarthritis grade was maintained. The mean operative time was 145 minutes. A significant linear correlation was observed between the operative time and cumulative volume of cases after performing a logarithmic transformation. The learning rate was calculated as 84%. CONCLUSIONS Arthroscopy-assisted latissimus dorsi tendon transfer is a technically demanding procedure; however, it can lead to significant improvements in overall shoulder pain and function. This study also confirmed a learning-curve effect for the aLD. The learning rate was 84%, indicating the existence of a long learning period. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Kotaro Yamakado
- Department of Orthopaedics, Fukui General Hospital, Fukui, Japan.
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Latissimus-dorsi-Transfer. ARTHROSKOPIE 2017. [DOI: 10.1007/s00142-017-0141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kanatlı U, Özer M, Ataoğlu MB, Öztürk BY, Gül O, Çetinkaya M, Ayanoğlu T. Arthroscopic-Assisted Latissimus Dorsi Tendon Transfer for Massive, Irreparable Rotator Cuff Tears: Technique and Short-Term Follow-Up of Patients With Pseudoparalysis. Arthroscopy 2017; 33:929-937. [PMID: 28024870 DOI: 10.1016/j.arthro.2016.09.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe a modified technique for arthroscopic-assisted transfer of the latissimus dorsi tendon in a selected group of patients with irreparable rotator cuff tears and pseudoparalysis and to evaluate its short-term results. METHODS Fifteen patients with irreparable rotator cuff tears and pseudoparalysis treated by arthroscopic-assisted latissimus dorsi tendon transfer were included. The mean patient age was 61.53 ± 6.24 years (range, 52-71 years). Patients were assessed with physical examination, University of California Los Angeles (UCLA) Score and Constant-Murley score, as well as visual analog scale score at a mean follow-up of 26.4 ± 2.58 months (range, 24-31 months). RESULTS At final follow-up, mean UCLA score increased to 27.47 ± 6.31 compared with the preoperative UCLA score of 6.53 ± 2.1 (P < .001). Constant-Murley score was 21 ± 7.41 and 59.73 ± 13.62 (P < .001), visual analog scale pain score was 7.47 ± 1.06 and 2.47 ± 0.91 (P < .001), active forward flexion was 58° ± 21.11° and 130° ± 30.05° (P < .001), active abduction was 51° ± 21.64° and 129.67° ± 25.45° (P < .001), and active external rotation was 13.33° ± 21.68° and 32° ± 18.03° (P < .001) preoperatively and postoperatively, respectively. Mean acromiohumeral distance was 3.13 ± 1.40 mm preoperatively, whereas it was 5.67 ± 1.67 mm postoperatively (P < .001). No significant complications requiring a revision surgery was observed during the final follow-up. CONCLUSIONS The modified technique of arthroscopic-assisted transfer of the latissimus dorsi tendon is a feasible, minimally invasive option for the surgical treatment of irreparable rotator cuff tears in a subset of patients with pseudoparalysis. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Ulunay Kanatlı
- Department of Orthopaedics & Traumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Mustafa Özer
- Department of Orthopaedics & Traumatology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey.
| | | | - Burak Yağmur Öztürk
- Department of Orthopaedics & Traumatology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Orkun Gül
- Department of Orthopaedics & Traumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Mehmet Çetinkaya
- Department of Orthopaedics & Traumatology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Tacettin Ayanoğlu
- Department of Orthopaedics & Traumatology, Gazi University School of Medicine, Ankara, Turkey
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Anastasopoulos PP, Alexiadis G, Spyridonos S, Fandridis E. Latissimus Dorsi Transfer in Posterior Irreparable Rotator Cuff Tears. Open Orthop J 2017; 11:77-94. [PMID: 28400877 PMCID: PMC5366394 DOI: 10.2174/1874325001711010077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/09/2016] [Accepted: 04/20/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Massive rotator cuff tears pose a difficult and complex challenge even for the experienced surgeon; inability to repair these tears by conventional means designates them as irreparable, while management becomes quite taxing. Several operative options have been suggested for the management of such lesions with varying degrees of success, while it is imperative to match patient demands and expectations to the predicted outcome. METHODS Research articles are examined and key concepts are discussed, in order to provide an evidence based review of the available literature. The anatomy and pathomechanics along with the indications, contraindications and surgical techniques are reported. RESULTS Transfer of the Latissimus dorsi has been used with success to restore shoulder function in deficits of the posterior rotator cuff. Although it can be used in a variety of settings, the ideal patient for a Latissimus dorsi tendon transfer is a young and active individual, with no glenohumeral osteoarthritis that has a severe disability and weakness related to an irreparable posterior cuff tear. CONCLUSION Tendon transfers have proved to be a successful treatment option in salvaging this difficult problem, providing pain relief and restoring shoulder function. Despite the excellent functional outcomes and pain suppression following operation, a variety of factors may affect the outcome; thus making indications and preoperative assessment a valuable component.
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Affiliation(s)
- Panagiotis P Anastasopoulos
- Hand Surgery-Upper Limb and Microsurgery Department, KAT General Hospital, Nikis 2 Str, Kifisia 145-61, Athens, Greece
| | - George Alexiadis
- Hand Surgery-Upper Limb and Microsurgery Department, KAT General Hospital, Nikis 2 Str, Kifisia 145-61, Athens, Greece
| | - Sarantis Spyridonos
- Hand Surgery-Upper Limb and Microsurgery Department, KAT General Hospital, Nikis 2 Str, Kifisia 145-61, Athens, Greece
| | - Emmanouil Fandridis
- Hand Surgery-Upper Limb and Microsurgery Department, KAT General Hospital, Nikis 2 Str, Kifisia 145-61, Athens, Greece
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[Irreparable rotator cuff tears. Debridement, partial reconstruction, tendon transfer or reversed shoulder arthroplasty]. DER ORTHOPADE 2016; 45:149-58. [PMID: 26768144 DOI: 10.1007/s00132-015-3204-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Therapeutic options for the treatment of irreparable rotator cuff tears are fluent, are dependent on the patients' claims and demands and on the grade of the ongoing cuff tear arthropathy.A partial rotator cuff reconstruction with sufficient tenolysis combined with interval slide techniques to restore the anterior and posterior force couple may be indicated if there is no fatty degeneration > grade 3 of the rotator cuff muscles in a well-centered joint. The margin convergence technique with side-by-side adaptation of the tendon limbs may reduce the load on the reconstructed tendons.The role of the suprascapular nerve, which can probably be constricted by the retracted rotator cuff, and its therapy has not been completely clarified. When distinct symptoms are present neurolysis may be reasonable.Tendon transfers can be indicated in a cooperative patient < 65 years with a higher grade of muscular atrophy but without degenerative changes > grade II according to Hamada with the loss of active external rotation but performable active flexion. For posterosuperior tears the latissimus dorsi or recently the teres major tendon transfer to the rotator cuff footprint may be appropriate. For nonreconstructable anterosuperior tears a partial transfer of the pectoralis major tendon is possible.Careful subacromial debridement combined with biceps tenotomy and a cautious or reversed decompression may reduce the pain temporarily without having an influence on active motion until with the loss of active elevation the indication for a reversed shoulder arthroplasty is reached.In the mean time, absorbable subacromial spacers may re-center the humeral head, but the effectiveness of this therapy on clinical outcome should be analyzed in further studies.
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Gervasi E, Maman E, Dekel A, Cautero E. Fluoroscopy-guided biodegradable spacer implantation using local anesthesia: safety and efficacy study in patients with massive rotator cuff tears. Musculoskelet Surg 2016; 100:19-24. [PMID: 27900707 PMCID: PMC5131084 DOI: 10.1007/s12306-016-0433-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 10/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The management of massive rotator cuff tears (MRCTs) is challenging and associated with a high failure rates. Studies have shown that advanced age, lower American Society of Anesthesiologists physical status score and concomitant comorbidities are associated with higher risks of death and postoperative complications. This study was designed to assess the safety and efficacy of fluoroscopy-guided biodegradable spacer implantation under local anesthesia, in patients with MRCT and comorbidities completely or partially contraindicating surgeries under general anesthesia. METHODS In this open-label, single arm, prospective study, subjects with MRCTs underwent subacromial fluoroscopy-guided implantation with a biodegradable spacer (InSpace™ system) under local anesthesia. Fifteen patients were treated and assessed. Follow-up visits were scheduled according to routine clinical practice. Shoulder function was evaluated using Constant (CS) and American Shoulder and Elbow Society (ASES) scores. RESULTS All patients demonstrated an overall improvement in the total CS and ASES beginning at 6 weeks and sustained by at least 12 months postoperatively. Of the 15 patients who reached the 1-year follow-up, 85% showed a clinically significant improvement of at least 15 points in their Constant score starting at 6 weeks postoperation and maintained throughout the entire follow-up period. CONCLUSIONS We conclude that in this initial patient's cohort, fluoroscopy-guided implantation of InSpace™ system under local anesthesia, represented an effective alternative to the existing procedures. This procedure may be considered as a treatment option for elderly patients or for patients with multiple comorbidities complicating or contraindicating surgery under general anesthesia. Technically easy, this technique can be an effective tool in the armamentarium of most orthopedic surgeons. Level of proof: single-arm prospective study, Level II.
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Affiliation(s)
- E Gervasi
- Department of Orthopedic Surgery, Latisana Civil Hospital, Via Sabbionera 45, Latisana, 33053, Udine, Italy.
| | - E Maman
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Dekel
- Advanced Orthopedic Clinic, Assuta Medical Center, Tel Aviv, Israel
| | - E Cautero
- Department of Orthopedic Surgery, Latisana Civil Hospital, Via Sabbionera 45, Latisana, 33053, Udine, Italy
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Bargoin K, Boissard M, Kany J, Grimberg J. Influence of fixation point of latissimus dorsi tendon transfer for irreparable rotator cuff tear on glenohumeral external rotation: A cadaver study. Orthop Traumatol Surg Res 2016; 102:971-975. [PMID: 28341266 DOI: 10.1016/j.otsr.2016.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 08/20/2016] [Accepted: 09/05/2016] [Indexed: 02/02/2023]
Abstract
UNLABELLED Latissimus dorsi tendon transfer is a surgical option for treating irreparable posterosuperior rotator cuff tears, notably when attempting to reconstruct active external rotation. We hypothesized that the positioning of the transfer's point of fixation would differ depending on the desired elbow-to-body external rotation or external rotation with the elbow abducted. MATERIAL AND METHODS Seven shoulders from four whole frozen cadavers were used. We created two systems to install the subject in a semi-seated position to allow external rotation elbow to body and the arm abducted 90°. Traction sutures were positioned on the latissimus dorsi muscle and a massive tear of the rotator cuff was created. We tested six different transfer positions. Muscle contraction of the latissimus dorsi was stimulated using 10-N and 20-N suspended weights. RESULTS The point of fixation of the latissimus dorsi on the humeral head had an influence on the elbow-to-body external rotation and with 90° abduction (P<0.001). The fixation point for a maximum external rotation with the elbow to the body was the anterolateral position (P<0.016). The fixation point for a maximum external rotation at 90° abduction was the position centered on the infraspinatus footprint (P<0.078). CONCLUSION The optimal point of fixation differs depending on whether external rotation is restored at 0° or 90° abduction. LEVEL OF EVIDENCE Fundamental study, anatomic study.
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Affiliation(s)
- K Bargoin
- Le Confluent-Nouvelles Cliniques Nantaises, Nantes, France.
| | - M Boissard
- Centre Hospitalier Universitaire, Nantes, France
| | - J Kany
- Clinique de l'Union, Saint Jean, France
| | - J Grimberg
- Institut de recherche en chirurgie orthopédique et sportive, Paris, France
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Petriccioli D, Bertone C, Marchi G. Recovery of active external rotation and elevation in young active men with irreparable posterosuperior rotator cuff tear using arthroscopically assisted latissimus dorsi transfer. J Shoulder Elbow Surg 2016; 25:e265-75. [PMID: 26952287 DOI: 10.1016/j.jse.2015.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 12/09/2015] [Accepted: 12/14/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Massive irreparable posterosuperior rotator cuff tears represent a serious functional disablement for young and active patients in their daily activities. Latissimus dorsi (LD) muscle-tendon transfer can restore elevation and external rotation where supraspinatus and infraspinatus function is lost. MATERIALS AND METHODS Between 2009 and 2013, 45 consecutive patients underwent arthroscopically assisted LD transfer for an irreparable posterosuperior rotator cuff tear. Thirty-three patients agreed to participate in this retrospective study. For 8 patients, we used a standard passage of the LD through the plane between the infraspinatus-teres minor and the deltoid muscles. For the remaining 25 patients, we transferred the LD tendon in front of the triceps muscle according to a personal described technique. The follow-up period was 35.7 months. Final follow-up included assessment by standard radiographs, bipolar surface electromyography, pain score by visual analog scale, Constant-Murley shoulder score, and Disabilities of the Arm, Shoulder, and Hand score. For quantitative strength evaluation measurements, a Biodex dynamometer was used. RESULTS Overall clinical outcomes improved at the final follow-up and were significantly age related. We found similar results for revision and primary patients with mean increase in Constant-Murley scores of 29.5 and 30.5 points, respectively. In our series, we recorded osteoarthritis progression in 33.3% of patients. CONCLUSION Arthroscopic LD tendon transfer for irreparable posterosuperior rotator cuff tears can achieve good clinical outcomes at a midterm follow-up, especially in active men 60 years of age or younger and in patients with low preoperative elevation (<80°) but an intact or reparable subscapularis tendon.
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Affiliation(s)
- Dario Petriccioli
- Department of Orthopedics, Istituto Clinico Città di Brescia, Brescia, Italy
| | - Celeste Bertone
- Department of Orthopedics, Istituto Clinico Città di Brescia, Brescia, Italy.
| | - Giacomo Marchi
- Department of Orthopedics, Istituto Clinico Città di Brescia, Brescia, Italy
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Cutbush K, Peter NA, Hirpara K. All-Arthroscopic Latissimus Dorsi Transfer. Arthrosc Tech 2016; 5:e607-13. [PMID: 27656385 PMCID: PMC5021352 DOI: 10.1016/j.eats.2016.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/04/2016] [Indexed: 02/03/2023] Open
Abstract
Massive irreparable rotator cuff tears are often associated with severe functional impairment and disabling pain. One viable treatment option is a latissimus dorsi tendon transfer. We propose an all-arthroscopic technique that we believe avoids insult to the deltoid musculature while reducing morbidity from open harvest of the tendon. The operation is performed with the patient in the lateral decubitus position, by use of a combination of viewing and working portals in the axilla. The initial viewing portal is placed along the anterior belly of the latissimus muscle in the axilla. The latissimus and teres major are identified, as is the thoracodorsal neurovascular pedicle. The tendons are carefully separated, and the inferior and superior borders of the latissimus are whipstitched using a suture passer, which helps facilitate subsequent mobilization of the muscle. The interval deep to the deltoid and superficial to the teres minor is developed into a subdeltoid tunnel for arthroscopic tendon transfer. The latissimus tendon is then transferred and stabilized arthroscopically to the supraspinatus footprint with suture anchors. Our preliminary data suggest that this surgical technique results in improvement in pain, range of motion, and function.
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Affiliation(s)
- Kenneth Cutbush
- University of Queensland, Brisbane, Australia,Brisbane Hand and Upper Limb Clinic, Brisbane, Australia,Orthopaedic Department, Princess Alexandra Hospital, Woolloongabba, Australia,Address correspondence to Kenneth Cutbush, M.B.B.S., F.R.A.C.S., F.A.Orth.A., 9/259 Wickham Terrace, Brisbane, 4000, Queensland, Australia.9/259 Wickham TerraceBrisbane4000, QueenslandAustralia
| | - Noel A. Peter
- Orthopaedic Department, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Kieran Hirpara
- Orthopaedic Department, Prince Charles Hospital, Chermside, Queensland, Australia
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Castricini R, De Benedetto M, Familiari F, De Gori M, De Nardo P, Orlando N, Gasparini G, Galasso O. Functional status and failed rotator cuff repair predict outcomes after arthroscopic-assisted latissimus dorsi transfer for irreparable massive rotator cuff tears. J Shoulder Elbow Surg 2016; 25:658-65. [PMID: 26589917 DOI: 10.1016/j.jse.2015.08.043] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic-assisted latissimus dorsi tendon transfer (LDTT) has been recently introduced for treatment of irreparable, posterosuperior massive rotator cuff tears. We sought to evaluate the functional outcomes of this technique and to check for possible outcome predictors. METHODS The study reviewed 86 patients (aged 59.8 ± 5.9 years) who underwent an arthroscopic-assisted latissimus dorsi tendon transfer after 36.4 ± 9 months of follow-up. Of these, 14 patients (16.3%) sustained an irreparable massive rotator cuff tear after a failed arthroscopic rotator cuff repair. The Constant and Murley score (CMS) was used to assess patients' functionality preoperatively and at follow-up. RESULTS As a group, the CMS improved with surgery from 35.5 ± 6.1 to 69.5 ± 12.3 (P < .001). A lower preoperative CMS and a previous failed rotator cuff repair resulted in lower postoperative range of motion (P = .044 and P = .007, respectively) and CMS (P = .042 and P = .018, respectively). A previous rotator cuff repair resulted in lower satisfaction with surgery (P = .009). Gender and age did not affect the clinical outcomes. CONCLUSIONS Our results support the effectiveness of arthroscopic-assisted LDTT in the treatment of patients with an irreparable, posterosuperior massive rotator cuff tears in pain relief, functional recovery, and postoperative satisfaction. Patients with lower preoperative CMS and a history of failed rotator cuff repair have a greater likelihood of having a lower clinical result. However, the favorable values of summary postoperative scores do not exclude these patients as candidates for arthroscopic-assisted LDTT.
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Affiliation(s)
- Roberto Castricini
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Massimo De Benedetto
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy
| | - Marco De Gori
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy
| | - Pasquale De Nardo
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy
| | - Nicola Orlando
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy.
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy
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Galasso O, Familiari F, Gasparini G. Treatment options for irreparable postero-superior cuff tears in young patients. World J Orthop 2015; 6:770-775. [PMID: 26601058 PMCID: PMC4644864 DOI: 10.5312/wjo.v6.i10.770] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 07/14/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Rotator cuff tears (RCTs) occur more commonly with advanced age, with most rotator cuff abnormalities in patients less than 30 years old being painful tendinoses or partial-thickness RCTs. Irreparable postero-superior cuff tears has been reported as frequent as 7% to 10% in the general population, and the incidence of irreparable RCTs in young patients is still unknown. Several surgical procedures have been proposed for young patients with irreparable postero-superior RCTs, such as rotator cuff debridement, partial rotator cuff repair, biceps tenotomy/tenodesis, rotator cuff grafting, latissimus dorsi tendon transfer, and reverse shoulder arthroplasty. After being thoroughly investigated in open surgery, arthroscopic techniques for latissimus dorsi tendon transfer have been recently described. They have been shown to be an adequate option to open surgery for managing irreparable postero-superior RCTs refractory to conservative management.
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Jermolajevas V, Kordasiewicz B. Arthroscopically Assisted Latissimus Dorsi Tendon Transfer in Beach-Chair Position. Arthrosc Tech 2015; 4:e359-63. [PMID: 26759777 PMCID: PMC4680951 DOI: 10.1016/j.eats.2015.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/13/2015] [Indexed: 02/03/2023] Open
Abstract
Irreparable rotator cuff tears remain a surgical problem. The open technique of latissimus dorsi (LD) tendon transfer to "replace" the irreparable rotator cuff is already well known. The aim of this article is to present a modified arthroscopically assisted LD tendon transfer technique. This technique was adopted to operate on patients in the beach-chair position with several improvements in tendon harvesting and fixation. It can be divided into 6 steps, and only 1 step-LD muscle and tendon release-is performed open. The advantages of the arthroscopic procedure are sparing of the deltoid muscle, the possibility of repairing the subscapularis tendon, and the ability to visualize structures at risk while performing tendon harvesting (radial nerve) and passing into the subacromial space (axillary nerve). It is performed in a similar manner to standard rotator cuff surgery-the beach-chair position does not need any modification, and no sophisticated equipment for either the open or arthroscopic part of the procedure is necessary. Nevertheless, this is a challenging procedure and should only be attempted after training, as well as extensive practice.
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Affiliation(s)
- Viktoras Jermolajevas
- Traumatology and Orthopedics Department, Klaipėda Regional Hospital, Klaipėda, Lithuania, Poland,Address correspondence to Viktoras Jermolajevas, M.D., Klaipėda Regional Hospital, S. Neries 3, Klaipėda, Lithuania, LT 92236.
| | - Bartlomiej Kordasiewicz
- Traumatology and Orthopedics Department, Postgraduate Medical Education Centre, SPSK im. A. Grucy, Otwock, Poland
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Paribelli G, Boschi S, Randelli P, Compagnoni R, Leonardi F, Cassarino AM. Clinical outcome of latissimus dorsi tendon transfer and partial cuff repair in irreparable postero-superior rotator cuff tear. Musculoskelet Surg 2015; 99:127-32. [PMID: 25904348 DOI: 10.1007/s12306-015-0353-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 03/24/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Irreparable rotator cuff tears are a common cause of pain in adult population, requiring in many cases a surgical treatment. Possible alternatives are debridement, partial repair, muscle transfers and joint replacement. We evaluated two groups of patients with irreparable rotator cuff tear treated surgically: one group received an arthroscopic-assisted latissimus dorsi tendon transfer (LDTT), and the other an arthroscopic rotator cuff partial repair. Aim of our study was to compare clinical results and quality of life in two groups of patients with massive irreparable rotator cuff tear: one receiving an arthroscopic LDTT and the other receiving an arthroscopic rotator cuff partial repair. METHODS Forty patients were assigned to two groups: 20 patients to group TT treated with LDTT and 20 patients to group PR treated with a partial repair. The average follow-up duration was 2.8 years (1-5, SD 3). Pre- and postoperative modified UCLA shoulder score, ROM, measurement of the strength and the rotator cuff quality of life (RC-QOL) were used to asses the outcome. RESULTS LDTT showed significative improvements when compared to partial repair in UCLA score results, strength and RC-QOL questionnaire. No differences were found between the groups in pain relief. CONCLUSION Both techniques are effective in reducing patients' symptoms. We believe that in younger, high-demanding patients with no or mild osteoarthritis, the LDTT represents a valid treatment option with better modified UCLA score improvement and strength at our follow-up.
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Grimberg J, Kany J, Valenti P, Amaravathi R, Ramalingam AT. Arthroscopic-assisted latissimus dorsi tendon transfer for irreparable posterosuperior cuff tears. Arthroscopy 2015; 31:599-607.e1. [PMID: 25498458 DOI: 10.1016/j.arthro.2014.10.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate, in a multicenter, prospective study, the clinical, magnetic resonance imaging (MRI), and radiologic results of arthroscopic-assisted latissimus dorsi (LD) tendon transfer for irreparable posterosuperior rotator cuff tears; and to assess the influence of perioperative data on clinical results. METHODS Fifty-five patients with irreparable tears of at least the supraspinatus and infraspinatus tendons were managed with arthroscopic-assisted LD tendon transfer and reviewed clinically, with standardized radiographs and MRI, after a mean of 29 months. Outcome measures included the Constant score and the Subjective Shoulder Value. The osteoarthritic stage and acromiohumeral distance were measured on standardized radiographs, and the transferred tendon aspect was evaluated on MRI. RESULTS Thirty patients had already undergone 1 or more previous surgical procedures. The mean Subjective Shoulder Value increased from 26% preoperatively to 71% postoperatively. The Constant score improved from 37 preoperatively to 65.4 postoperatively. The pain score increased from 1.7 preoperatively to 12.6 postoperatively; the activity score, from 6.4 to 13.8; active forward flexion, from 134° to 157°; active abduction, from 67° to 92.5°; active external rotation, from 29° to 41.5°; and abduction strength, from 1.4 kg to 4.8 kg. The only statistically significant factor negatively influencing the Constant score was previous surgery. Four patients had a ruptured LD tendon on MRI follow-up at 1 year. There was no statistical difference between preoperative and final follow-up acromiohumeral distance. There was no increase in osteoarthritic stage. CONCLUSIONS Arthroscopic-assisted LD tendon transfer improves shoulder pain and function in patients with irreparable posterosuperior cuff tears, with similar clinical and radiologic results compared with results of published series using open techniques. Patients with a history of surgery had lower Constant scores compared with non-previously operated patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Jean Grimberg
- L'Institut de Recherché en Chirurgie Orthopédique et Sportive, Paris, France.
| | - Jean Kany
- Clinique de l'Union, Saint Jean, France
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Abstract
PURPOSE Rotator cuff surgery is a rapidly evolving branch in orthopaedics, which has raised from a minor niche to a fully recognized subspecialty. This article summarizes its history, examining the development of its key principles and the technical advancements. METHODS Literature was thoroughly searched, and few senior surgeons were interviewed in order to identify the significant steps in the evolution of rotator cuff surgery. RESULTS A wide variety of surgical options is available to reduce pain and restore function after rotator cuff tears. Rotator cuff repair surgical techniques evolved from open to arthroscopic and are still in development, with new fixation techniques and biological solutions to enhance tendon healing being proposed, tested in laboratory and in clinical trials. Although good or excellent results are often obtained, there is little evidence that the results of rotator cuff repair are improving with the decades. An overall high re-tear rate remains, but patients with failed rotator cuff repairs can experience outcomes comparable with those after successful repairs. CONCLUSIONS Rotator cuff repair techniques evolve at a fast pace, with new solutions often being used without solid clinical evidence of superiority. It is necessary to conduct high-level clinical studies, in which data relating to anatomical integrity, patient self-assessed comfort and function, together with precise description of patient's condition and surgical technique, are collected. LEVEL OF EVIDENCE IV.
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De Casas R, Lois M, Cidoncha M, Valadron M. Clinic and electromyographic results of latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears. J Orthop Surg Res 2014; 9:83. [PMID: 25380558 PMCID: PMC4237752 DOI: 10.1186/s13018-014-0083-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/09/2014] [Indexed: 02/03/2023] Open
Abstract
Background This study examines the clinical and electromyographic results of latissimus dorsi transfer (LDT) using a combined open and arthroscopic technique for the treatment of symptomatic irreparable posterosuperior rotator cuff tears. Methods Between 2006 and 2009, LDT was performed in 14 patients (mean age 59 years) with massive and symptomatic irreparable posterosuperior rotator cuff tear. The patients were examined preoperatively and postoperatively with mean follow-up of 52 months using the Constant score, and the integrity of the latissimus dorsi (LD) transfer was assessed by ultrasound in all cases and by MRI in ten cases. The functional activity of the LD transfer was compared to the non-operated side using surface electromyography. Results All patients demonstrated a significant improvement in the Constant score (p = 0.001), from a preoperative score of 33 points (range 10–55 points) to a postoperative score of 59 points (range 13–80 points). The subjective assessment score was good to excellent in 12 patients (85%), and 11 patients (78%) would be willing to undergo surgery again. Integrity of the transferred tissue was confirmed in 13 of the 14 cases using ultrasound and MRI. Surface electromyographic signal showed increased activation of the transferred latissimus dorsi when performing active movements of external rotation (p = 0.002) and abduction-elevation (p = 0.009). Conclusions Our results indicate that LDT significantly improves function and diminishes pain in patients with a massive posterosuperior rotator cuff tear. The combined open and arthroscopic technique preserves the deltoid muscle and controls the LD tendon reinsertion. Surface electromyographic signal confirms the active function of the transferred muscle. Electronic supplementary material The online version of this article (doi:10.1186/s13018-014-0083-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ricardo De Casas
- Department of Orthopedic Surgery, Clinica Traumacor, Ronda de Nelle 72, 15005, A Coruna, Spain.
| | - Matías Lois
- Department of Orthopedic Surgery, Centro Gallego de Buenos Aires, Avenida Belgrano 2199, 1094, Buenos Aires, Argentina.
| | - Myriam Cidoncha
- Department of Physical Medicine, Clinica Traumacor, Ronda de Nelle 72, 15005, A Coruna, Spain.
| | - Miguel Valadron
- Department of Orthopedic Surgery, Clinica Traumacor, Ronda de Nelle 72, 15005, A Coruna, Spain.
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Black EM, Paxton ES, Williams GR, Song HS. Arthroscopic repair of an avulsed latissimus dorsi tendon transfer for massive, irreparable rotator cuff tear: a report of two cases. J Shoulder Elbow Surg 2014; 23:e217-20. [PMID: 25127912 DOI: 10.1016/j.jse.2014.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 05/08/2014] [Accepted: 05/15/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Eric M Black
- Department of Orthopedic Surgery, The Summit Medical Group, Berkeley Heights, NJ, USA
| | - E Scott Paxton
- Department of Orthopedic Surgery, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Gerald R Williams
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Hyun-Seok Song
- Department of Orthopedic Surgery, St. Paul's Hospital, The Catholic University of Korea, Seoul, South Korea.
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Castricini R, Longo UG, De Benedetto M, Loppini M, Zini R, Maffulli N, Denaro V. Arthroscopic-Assisted Latissimus Dorsi Transfer for the Management of Irreparable Rotator Cuff Tears: Short-Term Results. J Bone Joint Surg Am 2014; 96:e119. [PMID: 25031381 DOI: 10.2106/jbjs.l.01091] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Irreparable rotator cuff tears associated with shoulder functional impairment represent a challenge, especially in young and active patients. Latissimus dorsi muscle-tendon transfer is performed to replace the irreversibly lost contractile elements in patients with irreparable tears of the posterosuperior aspect of the rotator cuff. METHODS From 2008 to 2010, we enrolled twenty-seven patients (mean age, sixty years; range, forty-six to sixty-seven years) with irreparable, full-thickness rotator cuff tears involving at least two tendons who underwent arthroscopic-assisted latissimus dorsi muscle-tendon transfer. Outcome measures included the Constant and Murley score, shoulder range of motion in external rotation, and muscle strength in forward elevation. The mean duration of follow-up was twenty-seven months (range, twenty-four to thirty-six months). RESULTS There was a significant improvement (p < 0.05) in the mean Constant and Murley score, pain score, muscle strength in forward elevation, and range of motion in external rotation at the time of the last follow-up. There was no significant correlation between the mean preoperative range of motion, pain, and strength and the mean postoperative Constant and Murley score. There was no significant osteoarthritis progression and proximal migration of the humeral head after surgery in the time period studied. CONCLUSIONS Arthroscopic-assisted latissimus dorsi muscle-tendon transfer at short-term follow-up is an effective alternative to open surgery for the management of painful irreparable posterosuperior rotator cuff tears refractory to conservative management. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Roberto Castricini
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Via Corriera 1, 48010 Cotignola, Ravenna, Italy. E-mail address for R. Zini:
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy. E-mail address for U.G. Longo: . E-mail address for M. Loppini: . E-mail address for V. Denaro:
| | - Massimo De Benedetto
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Via Corriera 1, 48010 Cotignola, Ravenna, Italy. E-mail address for R. Zini:
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy. E-mail address for U.G. Longo: . E-mail address for M. Loppini: . E-mail address for V. Denaro:
| | - Raul Zini
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Via Corriera 1, 48010 Cotignola, Ravenna, Italy. E-mail address for R. Zini:
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England. E-mail address:
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy. E-mail address for U.G. Longo: . E-mail address for M. Loppini: . E-mail address for V. Denaro:
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Castricini R, De Benedetto M, Orlando N, Gervasi E, Castagna A. Irreparable rotator cuff tears: a novel classification system. Musculoskelet Surg 2014; 98 Suppl 1:49-53. [PMID: 24659197 DOI: 10.1007/s12306-014-0320-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 02/26/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Irreparable rotator cuff tears can be managed by several approaches. However, current tear classifications fail to reflect the wide variety of their presentation, which has important clinical and prognostic implications. METHODS We describe a novel classification system based on preoperative imaging findings and intraoperative observation where each cuff tendon (numbered sequentially: 1-supraspinatus, 2-infraspinatus, 3-teres minor, and 4-subscapularis) is assessed intraoperatively for reducibility to the footprint; tendons with reparable lesions are assessed for fatty degeneration (which predicts healing potential) and given a plus if degeneration is <50 % (Fuchs stage I-II/Goutallier stage 0-II) or a minus if it is ≥50 % (Fuchs stage III/Goutallier stage III-IV). RESULTS The proposed system (1) allows more consistent and reproducible classification of cuff tears where at least one tendon is irreparable; (2) results in more accurate diagnosis; (3) guides in treatment selection; and (4) ensures better outcomes and realistic patient expectations. CONCLUSIONS The novel classification system can contribute to develop increasingly exhaustive and reproducible classification models.
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Affiliation(s)
- R Castricini
- Department of Orthopaedic and Trauma Surgery, Casa di Cura Villa Verde, Fermo, Italy.
| | - M De Benedetto
- Department of Orthopaedic and Trauma Surgery, Casa di Cura Villa Verde, Fermo, Italy
| | - N Orlando
- Department of Orthopaedic and Trauma Surgery, Casa di Cura Villa Verde, Fermo, Italy
| | - E Gervasi
- Department of Orthopaedic and Trauma Surgery, Ospedale Civile, Latisana, Italy
| | - A Castagna
- Unit of Shoulder Surgery, Istituto Clinico Humanitas, Rozzano, Italy
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Grimberg J, Kany J. Latissimus dorsi tendon transfer for irreparable postero-superior cuff tears: current concepts, indications, and recent advances. Curr Rev Musculoskelet Med 2014; 7:22-32. [PMID: 24458942 PMCID: PMC4094122 DOI: 10.1007/s12178-013-9196-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Latissimus dorsi tendon transfer is a method for surgical treatment of massive irreparable posterosuperior cuff tears. It partially restores active anteflexion, external rotation, and function of the shoulder but does not significantly increase strength of the shoulder. It is contraindicated in case of pseudoparalytic shoulder; associated irreparable subscapularis tear, deltoid palsy, and in case of associated osteoarthritis, as an isolated procedure. Results are inferior when performed as a secondary procedure compared with a primary procedure. However, latissimus dorsi tendon transfer is an attractive solution to improve shoulder mobility and function of young and non osteoarthritic patients whose previous surgical treatment of massive postero-superior irreparable rotator cuff tear failed. As a primary procedure, latissimus dorsi tendon transfer competes with debridement, biceps tenotomy, and partial cuff repair. In association with reverse shoulder arthroplasty, it restores active external rotation in osteoarthritic patients with active external rotation deficit. New arthroscopic assisted techniques might improve results in the future.
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Affiliation(s)
- Jean Grimberg
- IRCOS (Institut de Recherche en Chirurgie Osseuse et Sportive), 6 avenue Alphonse XIII, 75016, Paris, France,
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Indikation, Technik und Ergebnisse von Sehnentransferoperationen. ARTHROSKOPIE 2014. [DOI: 10.1007/s00142-013-0770-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rotator cuff: biology and current arthroscopic techniques. Knee Surg Sports Traumatol Arthrosc 2012; 20:1003-11. [PMID: 22270674 DOI: 10.1007/s00167-012-1901-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 01/10/2012] [Indexed: 12/19/2022]
Abstract
UNLABELLED The present article summarizes current trends in arthroscopic rotator cuff repairs focusing on the used repair technique, potential influencing factors on the results, and long-term outcome after reconstruction of the rotator cuff. Moreover, different treatment options for the treatment for irreparable rotator cuff ruptures were described, and the results of additional augmentation of the repairs with platelet-rich plasma were critically analyzed. Based on the current literature, double-row repairs did not achieve superior clinical results compared to single-row repairs neither in the clinical results nor in the re-rupture rate. Multiple factors such as age, fatty infiltration, and initial rupture size might influence the results. If the rupture is not repairable, various options were described including cuff debridement, partial repair, tuberoplasty, or tendon transfers. The additional augmentation with platelet-rich plasma did not reveal any significant differences in the healing rate compared to conventional rotator cuff repairs. LEVEL OF EVIDENCE IV.
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Arthroscopically assisted latissimus dorsi transfer with a minimally invasive harvesting technique: surgical technique and anatomic study. Musculoskelet Surg 2012; 96 Suppl 1:S35-40. [PMID: 22528843 DOI: 10.1007/s12306-012-0188-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 02/26/2012] [Indexed: 10/28/2022]
Abstract
Latissimus dorsi musculotendinous transfer has been described for the treatment of massive rotator cuff defects. The aim of this paper is to present the relevant surgical anatomy of an arthroscopically assisted technique associated with a modified harvesting of the tendon. For tendon harvesting, a skin incision of about 5-6 cm in length is made in the axillary crease orthogonal to the longitudinal axis of the upper arm. For the musculotendinous transfer, we propose to increase vector action of the latissimus dorsi by passing the transferred tendon ahead the triceps muscle under or over the Teres Major and fixing the transferred tendon behind the humeral head center of rotation in a more posterolateral position. In order to check the feasibility and safety of this new surgical technique, two fresh-frozen adult cadaveric hemithorax specimens with an intact upper extremity were dissected, and the relationships between the tendons and local neurologic structures were described during various steps of the latissimus dorsi transfer procedure.
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Longo UG, Franceschetti E, Petrillo S, Maffulli N, Denaro V. Latissimus dorsi tendon transfer for massive irreparable rotator cuff tears: a systematic review. Sports Med Arthrosc Rev 2011; 19:428-37. [PMID: 22089293 DOI: 10.1097/jsa.0b013e3182390639] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Tendon transfers have been proposed as a possible solution to restore pain-free functions, strength, and range of motion in patients with massive and irreparable cuff tears. The aim of this review is to establish the outcomes of (1) latissimus dorsi tendon transfer (LDT-T) surgery performed as a single procedure or in combination with other muscle-tendon transfer procedures, replacement, or both; (2) LDT-T in primary and revision surgery for massive irreparable rotator cuff tears; (3) the LDT-T procedure in relation to subscapularis and teres minor integrity; (4) the LDT-T procedure in relation to the reattachment position on the humeral head of the transferred tendon; (5) the LDT-T procedure performed as a single or a double incision; (6) arthroscopic, open, or combined approach: and (7) the LDT-T procedure in patients with preoperative osteoarthritis and a nonosteoarthritic condition with the evaluation of osteoarthritis progression. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies of levels of evidence I-IV were included. The LDT-T surgical procedure, outcomes, and complications were evaluated. Twenty-two studies describing 493 shoulders in 487 patients were included in our study. There were no prospective randomized, controlled studies. LDT-T is a promising strategy for the management of massive and irreparable rotator cuff tears, even though no agreement was found on several aspects and options of LDT-T. Randomized prospective control studies are still awaited on this subject.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Trigoria Rome, Italy
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Diop A, Maurel N, Chang VK, Kany J, Duranthon LD, Grimberg J. Tendon fixation in arthroscopic latissimus dorsi transfer for irreparable posterosuperior cuff tears: an in vitro biomechanical comparison of interference screw and suture anchors. Clin Biomech (Bristol, Avon) 2011; 26:904-9. [PMID: 21689873 DOI: 10.1016/j.clinbiomech.2011.05.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 05/20/2011] [Accepted: 05/23/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND The fixation of the tendon to the bone remains a challenging problem in the latissimus dorsi tendon transfer for irreparable cuff tears and can lead to unsatisfactory results. A new arthroscopic method of tendon to bone fixation using an interference screw has been developed and the purpose of this study was to compare its biomechanical properties to the ones of a standard fixation technique with anchors. METHODS Six paired fresh frozen cadaveric human humeri were used. The freed latissimus dorsi tendon was randomly fixed to the humeral head with anchors or with interference screw after a tubularization procedure. Testing consisted to apply 200 cycles of tensile load on the latissimus dorsi tendon with maximal loads of 30 N and 60 N, followed by a load to failure test. The stiffness, displacements after cyclic loadings, ultimate load to failure, and site of failure were analysed. FINDINGS The stiffness was statistically higher for the tendons fixed with interference screws than for the ones fixed with anchors for both 30 N and 60 N loadings. Likewise, the relative bone/tendon displacements after cyclic loadings were lower with interference screws compared to anchors. Load to failure revealed no statistical difference between the two techniques. INTERPRETATION Compared to the standard anchor fixation, the interference screw fixation technique presents higher or similar biomechanical performance. These results should be completed by further biomechanical and clinical trials to confirm the interest of this new technique as an alternative in clinical use.
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Affiliation(s)
- Amadou Diop
- Equipe Biomécanique et Remodelage Osseux, Arts et Métiers ParisTech, France.
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