Basic Science
Functional status and failed rotator cuff repair predict outcomes after arthroscopic-assisted latissimus dorsi transfer for irreparable massive rotator cuff tears

https://doi.org/10.1016/j.jse.2015.08.043Get rights and content

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.

Section snippets

Study group

From March 2008 to December 2012, 111 patients underwent an arthroscopic-assisted LDTT by 1 surgeon (R.C.). In this retrospective study with prospective data collection, inclusion criteria were (1) an irreparable posterosuperior MRCT (1 and 2 according to Castricini et al5), (2) failure of conservative management for at least 6 months, (3) no concomitant subscapularis repair, and (4) no neurologic deficit. The decision for the surgical procedure was based on (1) preoperative magnetic resonance

Results

After a follow-up of 36.4 ± 9 months (range, 24-60 months), patients exhibited a mean forward flexion of 160° ± 28°, a mean abduction of 159° ± 27°, a mean external rotation of 43° ± 16°, and a median internal rotation to L3 (buttock-T7). All CMS domains significantly improved with surgery: pain, from 1.1 ± 2.1 to 13.7 ± 2.8; activities, from 10.6 ± 1.5 to 17.8 ± 3; ROM, from 22.2 ± 5.3 to 33.7 ± 6.9; and strength, from 1.6 ± 0.7 to 4.3 ± 2.3 (P < 0.001 for all, 100% power). Globally, the total

Discussion

Since the first description of LDTT, several studies have widely described clinical and radiologic results that can be expected after open surgery.17 Notably, the long-term series by Gerber et al13 proved that despite a moderate progression of degenerative changes on radiographs, clinical results after open LDTT are globally satisfactory and maintained beyond 10 years postoperatively.

Because arthroscopic-assisted LDTT has been introduced recently, only 3 clinical series have been published to

Conclusions

Our results support the effectiveness of arthroscopic-assisted LDTT in the treatment of patients with an irreparable, posterosuperior MRCT in pain relief, functional recovery, and postoperative satisfaction. Preoperative shoulder function and previous shoulder surgery influence the clinical result. 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 a summary postoperative

Acknowledgment

The authors gratefully acknowledge Jacob Joseph (research assistant, The Johns Hopkins University, Baltimore, MD, USA) for his helpful support in language editing and Ilaria Domenicano (PhD student, “La Sapienza” University, Rome, Italy) for her advice in statistics.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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