Clinical outcomes of latissimus dorsi tendon transfer and superior capsular reconstruction for irreparable rotator cuff tears: a systematic review

Abstract

Background Functionally irreparable rotator cuff tears (FIRCTs) present an ongoing challenge to the orthopedic surgeon. The aim of this systematic review was to critically compare the outcomes of three latissimus dorsi tendon transfer (LDT) techniques and two superior capsular reconstruction (SCR) techniques in treatment of FIRCTs. Methods A systematic review of studies evaluating the outcome of FIRCT treatment was performed via a search of four databases in April 2020. Each included study was reviewed in duplicate by two reviewers for evaluation of methodological quality. The treatments analyzed were arthroscopic LDT (aLDT), open LDT Gerber technique (oLDTG), open LDT L'Episcopo technique (oLDTL), SCR with allograft (SCR-Allo), and SCR with autograft (SCR-TFL). Demographics, range of motion, patient-reported outcome measures, radiographic acromiohumeral distance (AHD), treatment failures, and revisions were recorded. Results Forty-six studies (1287 shoulders) met criteria for inclusion. Twenty-three studies involved open latissimus transfer, with 445 shoulders undergoing oLDTG with mean follow-up of 63.2 months and 60 patients undergoing oLDTL with mean follow-up of 51.8 months. Ten studies (n = 369, F/U 29.2mo) reported on aLDT. Seven studies (n = 253, F/U 16.9mo) concerned SCR-Allo, and six studies (n = 160, F/U 32.mo) reported on SCR-TFL. Range of motion and subjective outcome scores improved in all techniques with no differences across treatments. Both SCR methods provided greater improvement in AHD than open LDT methods (p < 0.01). The re-tear rates were lower in both oLDT groups compared to the SCR groups (p = 0.03). Clinical failure rates were higher in the SCR-Allo and oLDTG groups, while overall treatment failures were lowest in oLDTL compared to all four other groups. Conclusion SCR techniques were associated with improved short-term radiographic acromiohumeral distance, while the open LDT techniques had lower tendon re-tear and treatment failure rates. All techniques resulted in improved clinical outcomes and pain relief compared to preoperative levels with no differences across techniques. Level of evidence IV Systematic review of case series and cohort studies.

Superior capsular reconstruction using hybrid graft for irreparable massive rotator cuff tear

“…In addition, the reliability of the measurement of each rotator cuff muscle was generally acceptable with an ICC of 0.817 for the supraspinatus, 0.731 for infraspinatus, and 0.684 for subscapularis. The post hoc analysis was performed based on the previous systematic review articles regarding massive RCT and SCR, and the power for the analysis of the healing failure rate after surgery was 60.1% with a sample size of 30 and an alpha error of 0.05 [3, 44]. All descriptive and analytic analyses were conducted using SPSS version 17.0 software for Windows (SPSS Inc., Chicago, Illinois).…”

A novel comorbidity risk score for predicting postoperative 30-day complications in total shoulder arthroplasty and elucidation of potential racial disparities

“…13 , 35 Complications occur in approximately 15% of patients undergoing SA, 15 meaning over 40,000 patients may experience postoperative complications following SA in the year of 2025. 5 , 35 Some of the most common complications following SA include instability, loosening, infection, notching, nerve injury, and fractures. Many of which may require reoperation.…”

“…Many of which may require reoperation. 5 , 15 , 35 Although some adverse outcomes are inherent to surgery, many can be mitigated by early identification of those who may be at increased risk of postoperative complications. Efficient and effective preoperative identification of those patients with elevated risk may allow for more cost-effective interventions, accurate bundled payment adjustments, and overall improved patient care.…”