Gerber assessed whether latissimus dorsi tendon transfer for irreparable massive rotator cuff tears could close the defect with vascularized tendon, depress the humeral head, act as an external rotator, and restore shoulder function.
16 shoulders treated at the University of Bern, Switzerland, reviewed at an average of 33 months.
Methods
Patients
16 irreparable massive rotator cuff tears in 16 patients
12 with a functional subscapularis
4 without a functioning subscapularis
Treatment
Latissimus dorsi tendon transfer
Acromioplasty
Follow-up
Average 33 months (range 26 to 41)
Outcomes
Pain at rest and on exertion
Active flexion and external rotation
Constant score as a percentage of the age- and gender‑adjusted normal
Superior migration of the humeral head
EMG of the suprascapular and thoracodorsal nerves in 11 patients
Key Findings
Function averaged 73% of a normal score adjusted for age and gender across all 16 shoulders: 82% in the 12 with a functional subscapularis vs 48% in the 4 without one.
Pain relief was rated satisfactory in 94% of shoulders at rest and 81% on exertion.
Flexion rose from 83° to 135° on average, but the 4 shoulders without subscapularis function gained only 6° (to 91°) vs 67° (to 149°) in the other 12.
Active external rotation improved by only 13°, to 23°, though external rotation strength returned to grade 4 of 5 in all but 2 patients.
Testing suggested the latissimus did not act as an active head depressor, and superior migration increased in 4 shoulders, all with an inadequately repaired degenerative subscapularis tear.
No infections or neurovascular complications occurred, and one sterile axillary seroma was treated with aspiration and a compression dressing.
Board pearl
The transfer depends on the subscapularis: Gerber found it of no value when a torn subscapularis could not be adequately repaired, so it suits irreparable external rotator defects with a working subscapularis.
Authors' conclusion
In cases with good subscapularis function but irreparable defects in the external rotator tendons, restoration of approximately 80% of normal shoulder function was obtained, indicating that latissimus dorsi transfer is a safe and valuable alternative for the treatment of this specific type of irreparable rotator cuff tear.
Gerber assessed whether latissimus dorsi tendon transfer for irreparable massive rotator cuff tears could close the defect with vascularized tendon, depress the humeral head, act as an external rotator, and restore shoulder function.
16 shoulders treated at the University of Bern, Switzerland, reviewed at an average of 33 months.
Methods
Patients
16 irreparable massive rotator cuff tears in 16 patients
12 with a functional subscapularis
4 without a functioning subscapularis
Treatment
Latissimus dorsi tendon transfer
Acromioplasty
Follow-up
Average 33 months (range 26 to 41)
Outcomes
Pain at rest and on exertion
Active flexion and external rotation
Constant score as a percentage of the age- and gender‑adjusted normal
Superior migration of the humeral head
EMG of the suprascapular and thoracodorsal nerves in 11 patients
Key Findings
Function averaged 73% of a normal score adjusted for age and gender across all 16 shoulders: 82% in the 12 with a functional subscapularis vs 48% in the 4 without one.
Pain relief was rated satisfactory in 94% of shoulders at rest and 81% on exertion.
Flexion rose from 83° to 135° on average, but the 4 shoulders without subscapularis function gained only 6° (to 91°) vs 67° (to 149°) in the other 12.
Active external rotation improved by only 13°, to 23°, though external rotation strength returned to grade 4 of 5 in all but 2 patients.
Testing suggested the latissimus did not act as an active head depressor, and superior migration increased in 4 shoulders, all with an inadequately repaired degenerative subscapularis tear.
No infections or neurovascular complications occurred, and one sterile axillary seroma was treated with aspiration and a compression dressing.
Board pearl
The transfer depends on the subscapularis: Gerber found it of no value when a torn subscapularis could not be adequately repaired, so it suits irreparable external rotator defects with a working subscapularis.
Authors' conclusion
In cases with good subscapularis function but irreparable defects in the external rotator tendons, restoration of approximately 80% of normal shoulder function was obtained, indicating that latissimus dorsi transfer is a safe and valuable alternative for the treatment of this specific type of irreparable rotator cuff tear.