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Massive irreparable rotator cuff tears

Treatment options, indications, and role of fully arthroscopic latissimus dorsi transfer

Massive irreparable Rotatorenmanschettenrupturen

Behandlungsoptionen, Indikationen und Bedeutung des vollständig arthroskopischen Latissimus-dorsi-Transfers

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Abstract

Management of massive irreparable posterosuperior rotator cuff tears is a surgical challenge, particularly in young active patients without any signs of osteoarthritis. Different surgical techniques have been described. To the three main deficits of active range of motion previously reported for a massive irreparable cuff tear, i.e., isolated loss of active elevation (ILEA), isolated loss of active external rotation (ILER), and combined loss of elevation and external rotation (CLEER), we add two new entities: isolated loss of active internal rotation (ILIR) and combined loss of active elevation and active internal rotation (CLEIR). We suggest that a combined deficit (CLEER or CLEIR) could lead to a new definition of a pseudoparalytic shoulder and propose a novel algorithm to redefine the role of latissimus dorsi transfer in each of these situations. We also describe a fully arthroscopic latissimus dorsi transfer technique that prevents any deltoid muscle insult, offers better visualization of the neighboring neurovascular structures at risk, and allows simultaneous management of biceps pathology and partial rotator cuff repair.

Zusammenfassung

Die Behandlung massiver irreparabler posterosuperiorer Rotatorenmanschettenrupturen stellt eine operative Herausforderung dar, insbesondere bei jungen aktiven Patienten ohne Anzeichen einer Arthrose. Verschiedene Operationstechniken wurden beschrieben. Zu den bisher beschriebenen 3 Hauptdefiziten des aktiven Bewegungsumfangs („range of motion“) bei einer massiven irreparablen Rotatorenmanschettenruptur, d. h. isolierter Verlust der aktiven Armhebung (ILEA), isolierter Verlust der aktiven Außenrotation (ILER) und kombinierter Verlust der Armhebung und Außenrotation (CLEER), fügen die Autoren 2 neue Entitäten hinzu: isolierter Verlust der aktiven Innenrotation (ILIR) und kombinierter Verlust der aktiven Armhebung und aktiven Innenrotation (CLEIR). Ein kombiniertes Defizit (CLEER oder CLEIR) könnte zu einer neuen Definition der pseudoparalytischen Schulter führen. Die Autoren schlagen einen neuen Algorithmus vor, um die Rolle des Latissimus-dorsi-Transfers in diesen Situationen neu zu definieren. Auch wird die Technik eines vollständig arthroskopischen Latissimus-dorsi-Transfers beschrieben, der Verletzungen des M. deltoideus verhindert, eine bessere Visualisierung gefährdeter benachbarter neurovaskulärer Strukturen bietet und die gleichzeitige Behandlung von Bizepspathologien sowie die Rekonstruktion von Teilrupturen der Rotatorenmanschette erlaubt.

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Authors and Affiliations

  1. Clinique de l’Union, Boulevard de Ratalens, 31240, Saint Jean, Toulouse, France

    Jean Kany MD

  2. Orthopedic department, Zagazig University, Zagazig, Egypt

    Hisham Anis M.Sc

  3. Orthopedic department, Hopital Ambroise Pare, Paris, France

    Jean David Werthel MD

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  1. Jean Kany MD
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  2. Hisham Anis M.Sc
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  3. Jean David Werthel MD
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Correspondence to Jean Kany MD.

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Conflict of interest

J. Kany is consultant for VIMS & DePuy, Mitek and receives royalties from FH Orthopedics (Arrow shoulder prosthesis). J.D. Werthel receives royalties from FH Orthopedics (Arrow shoulder prosthesis). H. Anis declares that he has no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Kany, J., Anis, H. & Werthel, J.D. Massive irreparable rotator cuff tears. Obere Extremität 13, 246–254 (2018). https://doi.org/10.1007/s11678-018-0478-9

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