Latissimus Dorsi Tendon Transfer for Treatment of Irreparable Posterosuperior Rotator Cuff Tears: Long-Term Results at a Minimum Follow-up of Ten Years
Christian Gerber, Stefan Rahm, Sabrina Catanzaro, Mazda Farshad & Beat K Moor
abstract
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BACKGROUND
Transfer of the latissimus dorsi tendon to the greater tuberosity of
the humerus for treatment of an irreparable rotator cuff tear has
been reported to yield good-to-excellent short to intermediate-term
results in well-selected patients. The purpose of this study was to
evaluate the long-term outcome of such transfers for irreparable
posterosuperior rotator cuff tears to determine the durability of
the results and to identify risk factors for an unfavorable
outcome.
METHODS
Fifty-seven shoulders in fifty-five patients (seventeen women and
thirty-eight men with a mean age of fifty-six years) were managed
with latissimus dorsi tendon transfer. Final follow-up was performed
at a mean of 147 months. Outcome measures included the Constant
score and the Subjective Shoulder Value (SSV). Osteoarthritis, the
acromiohumeral distance, and the so-called critical shoulder angle
were assessed on standardized radiographs.
RESULTS
Forty-six shoulders in forty-four patients were available at the
time of final follow-up. The mean SSV increased from 29%
preoperatively to 70% at the time of final follow-up, the relative
Constant score improved from 56% to 80%, and the pain score improved
from 7 to 13 points (p < 0.0001 for all). Mean flexion
increased from 118° to 132°, abduction increased from
112° to 123°, and external rotation increased from 18°
to 33°. Mean abduction strength increased from 1.2 to 2.0 kg (p
= 0.001). There was a slight but significant increase in
osteoarthritic changes. Inferior results occurred in shoulders with
insufficiency of the subscapularis muscle and fatty infiltration of
the teres minor muscle. Superior functional results were observed in
shoulders with a small postoperative critical shoulder angle.
CONCLUSIONS
Latissimus dorsi tendon transfer offered an effective treatment for
irreparable posterosuperior rotator cuff tears, with substantial and
durable improvements in shoulder function and pain relief. Shoulders
with fatty infiltration of the teres minor muscle and insufficiency
of the subscapularis muscle tended to have inferior results, as did
those with a large critical shoulder angle.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete
description of levels of evidence.
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citation
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Gerber C, rahm s, Catanzaro S, Farshad M, Moor B K. Latissimus Dorsi
Tendon Transfer for Treatment of Irreparable Posterosuperior Rotator
Cuff Tears: Long-Term Results at a Minimum Follow-up of Ten Years. J
Bone Joint Surg Am 2013; 95:1920-6.
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type
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journal paper/review (English)
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date of publishing
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6-11-2013
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journal title
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J Bone Joint Surg Am (95/21)
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ISSN electronic
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1535-1386
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pages
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1920-6
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PubMed
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24196461
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DOI
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10.2106/JBJS.M.00122
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