Gerber, J Bone Joint Surg Am 2013 - Latissimus Dorsi Tendon Transfer for Treatment of Irreparable Posterosuperior Rotator Cuff Tears: Long-Term Results at a Minimum Follow-Up of Ten Years - Article Summary

Latissimus Dorsi Tendon Transfer for Treatment of Irreparable Posterosuperior Rotator Cuff Tears: Long-Term Results at a Minimum Follow-Up of Ten Years

Gerber, Moor, et al.·J Bone Joint Surg Am·2013·317 citations·Prospective cohort

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

57 shoulders in 55 patients (17 women and 38 men with a mean age of 56 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

46 shoulders in 44 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. Copyright remains with the authors and publisher.

Supplemental

Latissimus Dorsi Tendon Transfer for Treatment of Irreparable Posterosuperior Rotator Cuff Tears: Long-Term Results at a Minimum Follow-Up of Ten Years.

Gerber, Moor, et al.J Bone Joint Surg Am2013317 citationsProspective cohort