Basic ScienceFunctional status and failed rotator cuff repair predict outcomes after arthroscopic-assisted latissimus dorsi transfer for irreparable massive rotator cuff tears
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.
References (34)
- et al.
Health-related quality of life and functionality after reverse shoulder arthroplasty
J Shoulder Elbow Surg
(2013) - et al.
The insertional footprint of the rotator cuff: an anatomic study
Arthroscopy
(2006) - et al.
Tuberoplasty: creation of an acromiohumeral articulation–a treatment option for massive, irreparable rotator cuff tears
J Shoulder Elbow Surg
(2002) - et al.
Arthroscopic latissimus dorsi transfer
Arthroscopy
(2007) - et al.
Arthroscopic-assisted latissimus dorsi tendon transfer for irreparable posterosuperior cuff tears
Arthroscopy
(2015) - et al.
Results of arthroscopic decompression and tuberoplasty for irreparable massive rotator cuff tears
Arthroscopy
(2011) - et al.
Reversed arthroscopic subacromial decompression for massive rotator cuff tears
J Shoulder Elbow Surg
(2004) - et al.
Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa
J Shoulder Elbow Surg
(2004) - et al.
Reversed arthroscopic subacromial decompression for symptomatic irreparable rotator cuff tears: mid-term follow-up results in 34 shoulders
J Shoulder Elbow Surg
(2010) - et al.
Shoulder arthroplasty: evolving techniques and indications
Joint Bone Spine
(2010)
Results of arthroscopic partial repair of large retracted rotator cuff tears
Arthroscopy
The Constant score in normal shoulders
J Shoulder Elbow Surg
Transfer of latissimus dorsi for irreparable rotator-cuff tears
J Bone Joint Surg Br
Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair
J Orthop Traumatol
Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears
J Bone Joint Surg Am
Irreparable rotator cuff tears: a novel classification system
Musculoskelet Surg
Arthroscopic-assisted latissimus dorsi transfer for the management of irreparable rotator cuff tears: short-term results
J Bone Joint Surg Am
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Response to Lievano regarding: “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”
2024, Journal of Shoulder and Elbow SurgeryTreatment of irreparable rotator cuff tear with dual graft reconstruction: a case report and technique description
2023, JSES Reviews, Reports, and TechniquesEarly postoperative recovery comparisons of superior capsule reconstruction to tendon transfers
2023, Journal of Shoulder and Elbow SurgeryCitation Excerpt :Tendon transfers have a long history of successfully restoring the dynamic anterior-posterior force couple in the open setting, particularly with the latissimus dorsi,16,22,24,26,46,64 and more recently the lower trapezius.19 Additionally, recent years have seen promise when these transfers are performed via a minimally invasive arthroscopically assisted technique.7,8,17,29,32,59,67 Given there remains a scarcity of comparative studies to date between any of these techniques, particularly the SCR and tendon transfers, we performed a comparative study focused on the early patient-reported pain and functional recovery curves for SCR and arthroscopically assisted tendon transfers.
Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears Results in Significant Improvements in Patient Reported Outcomes and Range of Motion: A Systematic Review
2022, Arthroscopy, Sports Medicine, and Rehabilitation
This study was approved by the Villa Maria Cecilia Hospital Institutional Review Board (ID 01/2015) and performed in compliance with the Declaration of Helsinki.