Combined single-stage reverse total shoulder arthroplasty (RTSA)
plus latissimus dorsi transfer (LDT) has been reported to be a
reliable treatment for pseudoparalysis of elevation and external
rotation caused by irreparable rotator cuff tears. Secondary LDT in
patients with pseudoparalysis of external rotation after previous
RTSA has not yet been studied.
Ten patients were treated with LDT at a mean of 27 months (range,
4-134 months) after RTSA. Standard LDT was performed in 4 patients
and a LDT plus teres major transfer according to L'Episcopo in 6
patients. All patients had preoperative and postoperative clinical
evaluation, including the assessment of the Constant score and the
subjective shoulder value.
RTSA increased the preoperative mean relative Constant score from
26% (range, 11%-67%) to 51% (range, 20%-100%; P = .05). At
a mean of 49 months (range, 23-67 months) after additional LDT, the
relative Constant score further increased to 58% (range, 34%-100%;
P = .141), remaining significantly superior to the score
before RTSA (P = .021). The mean subjective shoulder value
was 15% (range, 0%-30%) before and 44% (range, 20%-70%) after RTSA
(P = .273) and was 56% (range, 20%-90%) after LDT
(P = .686), a significant overall improvement of the state
of the shoulder compared with before RTSA (P = .042). Mean
active flexion increased from 36° (range, 0°-130°) to
86° (range, 10°-140°) after RTSA (P = .024)
and to 109° (range,70°-140°) after LDT
(P = 0.017 compared with pre-LDT; P = .011
compared with pre-RTSA). Mean active external rotation decreased
from 0° (range, -80° to 50)° to -18° (range,
-50°to 10)° after RTSA (P = .079) and was improved
to 2° (-40° to 40)° after LDT (P = .24
compared with pre-LDT; P=.865 compared with pre RTSA).
Secondary LDT significantly improves active mobility in patients
with residual dysfunction after RTSA.