Ozturk, J Shoulder Elbow Surg 2021 - Prospective, Randomized Evaluation of Latissimus Dorsi Transfer and Superior Capsular Reconstruction in Massive, Irreparable Rotator Cuff Tears

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Prospective, Randomized Evaluation of Latissimus Dorsi Transfer and Superior Capsular Reconstruction in Massive, Irreparable Rotator Cuff Tears

Ozturk, Kulduk, et al.·J Shoulder Elbow Surg·2021·62 citations

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Ozturk and colleagues compared arthroscopy‑assisted latissimus dorsi transfer with superior capsular reconstruction for massive irreparable rotator cuff tears, with and without pseudoparalysis.

Randomized prospective single‑surgeon study of 42 patients enrolled 2017 to 2018, with 41 analyzed at a mean 31 months.

Both techniques would give similar significant improvements in shoulder function in patients with and without chronic pseudoparalysis.

Key Findings

Both groups improved in ASES, WORC, VAS and Constant scores. Mean gains were larger after SCR for ASES (58.4 vs 45.5 points, p = 0.007) and Constant (44.5 vs 32.9, p = 0.008).
Pseudoparalysis reversed in 12 of 13 SCR patients vs 5 of 11 LDT patients (p = 0.011).
Gains in WORC, pain and motion did not differ significantly between groups. Final pain was lower after SCR (mean VAS 1.4 vs 2.7, p = 0.033).
AHD rose significantly within the LDT group (5.6 to 7.3 mm, p = 0.006) but not the SCR group (7.1 to 7.5 mm, p = 0.243). The between‑group difference in change was not significant (p = 0.055), so the authors' "better radiologic results" for LDT reflects the within‑group change only.
Each group had 1 graft failure. Septic arthritis after LDT required graft removal and left a stiff shoulder, and 1 SCR graft ruptured after a fall.
Neither group showed Hamada arthritis progression at final follow‑up. The authors note that follow‑up was too short to observe arthritic progression.

Authors' conclusion

Both SCR and LDT yielded promising short-term results in treatment of massive, irreparable rotator cuff tears in this study. The SCR group displayed better overall outcomes clinically, particularly in the pseudoparalytic shoulders, whereas the LDT group displayed better radiologic results.

Prospective, Randomized Evaluation of Latissimus Dorsi Transfer and Superior Capsular Reconstruction in Massive, Irreparable Rotator Cuff Tears.

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Prospective, Randomized Evaluation of Latissimus Dorsi Transfer and Superior Capsular Reconstruction in Massive, Irreparable Rotator Cuff Tears

Ozturk, Kulduk, et al.·J Shoulder Elbow Surg·2021·62 citations

|||

Ozturk and colleagues compared arthroscopy‑assisted latissimus dorsi transfer with superior capsular reconstruction for massive irreparable rotator cuff tears, with and without pseudoparalysis.

Randomized prospective single‑surgeon study of 42 patients enrolled 2017 to 2018, with 41 analyzed at a mean 31 months.

Both techniques would give similar significant improvements in shoulder function in patients with and without chronic pseudoparalysis.

Key Findings

Both groups improved in ASES, WORC, VAS and Constant scores. Mean gains were larger after SCR for ASES (58.4 vs 45.5 points, p = 0.007) and Constant (44.5 vs 32.9, p = 0.008).
Pseudoparalysis reversed in 12 of 13 SCR patients vs 5 of 11 LDT patients (p = 0.011).
Gains in WORC, pain and motion did not differ significantly between groups. Final pain was lower after SCR (mean VAS 1.4 vs 2.7, p = 0.033).
AHD rose significantly within the LDT group (5.6 to 7.3 mm, p = 0.006) but not the SCR group (7.1 to 7.5 mm, p = 0.243). The between‑group difference in change was not significant (p = 0.055), so the authors' "better radiologic results" for LDT reflects the within‑group change only.
Each group had 1 graft failure. Septic arthritis after LDT required graft removal and left a stiff shoulder, and 1 SCR graft ruptured after a fall.
Neither group showed Hamada arthritis progression at final follow‑up. The authors note that follow‑up was too short to observe arthritic progression.

Authors' conclusion

Both SCR and LDT yielded promising short-term results in treatment of massive, irreparable rotator cuff tears in this study. The SCR group displayed better overall outcomes clinically, particularly in the pseudoparalytic shoulders, whereas the LDT group displayed better radiologic results.

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