Latissimus dorsi transfer for massive posterosuperior rotator cuff tears: what affects the postoperative outcome?

Moursy, Mohamed; Schmalzl, Jonas; Kadavkolan, Aditya Sai; Bartels, Niko; Lehmann, Lars

doi:10.1016/j.jse.2019.03.028

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…For irreparable PSRCT, previous studies reported the theoretical improvement of the external rotation after LDT, rebalancing the force couple of infraspinatus and teres minor muscles, as well as its ability to depress the humeral head (19), while other studies showed only suboptimal improvement. The electromyographic response in the transferred latissimus dorsi muscle was stronger during adduction than during external rotation (20), and more rehabilitation and adaptation are required for better synergic movement of latissimus dorsi tendon (21). Retear after latissimus dorsi transfer was also reported in some patients (22,23).…”

Section: Discussionmentioning

confidence: 98%

Early Efficacy Assessment of Arthroscopic Lower Trapezius Transfer With Tendon Autograft in the Management of Massive Irreparable Posterosuperior Rotator Cuff Tears

Han

Zhang

et al. 2022

Front. Surg.

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Objectives: To explore the indications and surgical techniques for arthroscopic lower trapezius transfer (LTT) with tendon autograft in managing massive irreparable posterosuperior rotator cuff tears (PSRCTs); to validate the feasibility, safety, and efficacy of this technique.Methods: This study retrospectively enrolled 23 patients with massive irreparable PSRCTs, admitted to and followed up by the Taizhou Hospital of Zhejiang province between July 2020 and April 2021, and treated with ipsilateral LTT and ipsilateral hamstring tendon autograft. The control group consisted of 23 patients with massive RCTs receiving conventional repair procedures within the same frame. Follow-up data at the preoperative visit, and postoperative month 3 were collected to assess the active range of motion, Constant–Murley Score (CMS),American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), University of California, Los Angeles (UCLA)shoulder score, visual analog scale (VAS)and the post-operative MRI results, all of which could provide a comprehensive postoperative early efficacy assessment.Results: Three months follow-up visits were completed for all patients, revealing improvements in all aspects compared to the preoperative state, with no complications, such as postoperative infection of surgical sites and nerve injuries of infection and nerve injury. The distribution of active shoulder range of motion of patients and function scores with two types of operation was as follow: angles of flexion and lifting (130.00° ± 31.55° vs. 90.78° ± 19.85°), abduction (123.26° ± 30.47°vs. 85.87° ± 18.74°), external rotation at side (101.74° ± 14.74° vs. 91.74° ± 11.92°), external rotation at 90° abduction (41.52° ± 21.97° vs. 24.57° ±12.60°), VAS (0.74± 0.81 vs. 1.87 ±0.87), CMS(56.3 ± 13.01 vs. 48.30 ± 8.38), UCLA shoulder score (24.04 ± 2.88 vs.20.96 ± 3.47), ASES (72.91 ± 9.99 vs.60.74 ± 8.84). Significantly better improvements were found in the study group on month 3.19 of 23 patients in the study group and 17 of 23 patients in the control group underwent MRI on the 3 months follow up. Retear was found in only one patient who had grade 4 subscapularis tendon injury, However, revision was not performed due to postoperative pain relief and functional improvement.Conclusion: Compared to conventional repair procedures, in the early postoperative period, LTT with tendon autograft could achieve better pain relief, more rapid motor functional recovery, and higher functional scores for massive irreparable PSRCTs.

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Section: Discussionmentioning

confidence: 98%

Early Efficacy Assessment of Arthroscopic Lower Trapezius Transfer With Tendon Autograft in the Management of Massive Irreparable Posterosuperior Rotator Cuff Tears

Han

Zhang

et al. 2022

Front. Surg.

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“…[33] In an observational study conducted 10 years after surgery, the results showed that LDT has a good function in the treatment of IRCTs. [34] A review of the literature found that for patients with IRCTs, active flexion of the shoulder joint before tendon transposition > 120° had better postoperative results, [31] and patients with preoperative SSV scores <40 points had poor postoperative function, [35] which indicates that LDT may be more effective for patients with better shoulder joint function.…”

Section: Discussionmentioning

confidence: 99%

Multiple surgical treatment comparisons for irreparable rotator cuff tears: A network meta-analysis

et al. 2023

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Background: To evaluate the effect of different surgical methods in the treatment of patients with irreparable rotator cuff tears (IRCTs) using a network meta-analysis. Methods: A search of the PubMed, EMbase, The Cochrane Library, VIP, WanFang Data, and CNKI databases was performed in January 2023 to search for randomized controlled trials and cohort studies of different surgical methods in the treatment of IRCTs. Risk assessment of the included randomized controlled trials was conducted using the risk of bias assessment tool recommended by the Cochrane Manual, and the Newcastle-Ottawa Scale was used for the risk assessment of cohort studies. Data were analyzed and plotted using Stata 15.0 software. Results: A total of 17 studies involving 2123 patients and 10 surgical methods were included in this study. According to the surface under the cumulative ranking curve, the probability ranking in descending order is latissimus dorsi transfer (LDT) + partial repair > LDT > reverse total shoulder arthroplasty > superior capsular reconstruction > patch > partial repair > debridement + tenotomy of the long head of the biceps > debridement > in space subacromial balloon spacer + tenotomy of the long head of the biceps > in space subacromial balloon spacer. Conclusion: Among the multiple surgical treatments for patients with IRCTs, LDT + partial repair may have the best effect, and more randomized controlled trials with larger sample sizes are needed for further verification.

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“…Strengthening can start from four months. 47,57e59 Moursy et al 60 suggested a shorter period of immobilisation following LD transfer. The shoulder was immobilised in 30 of external rotation and 45 of abduction before active exercises commenced at four weeks, avoiding pain provoking movements.…”

Section: Lower Trapezius and Latissimus Dorsi Transfermentioning

confidence: 99%

Tendon transfers for irreparable rotator cuff tears

Adam

Nanjayan

Johnson

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Symptomatic irreparable rotator cuff tears pose a challenge for shoulder surgeons. Whilst reverse polarity shoulder arthroplasty is an effective option for older symptomatic patients who have exhausted conservative management, the optimal treatment for younger patients remains controversial. In this article we outline the main tendon transfer options, including anatomical considerations, indications, contraindications, surgical technique, complications and a review of the evidence. Tendon transfers provide an alternative joint-preserving surgical option, but the evidence so far is limited, with a clear need for well-designed comparative studies to confirm their effectiveness.

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Latissimus dorsi transfer for massive posterosuperior rotator cuff tears: what affects the postoperative outcome?

Cited by 9 publications

References 29 publications

Early Efficacy Assessment of Arthroscopic Lower Trapezius Transfer With Tendon Autograft in the Management of Massive Irreparable Posterosuperior Rotator Cuff Tears

Early Efficacy Assessment of Arthroscopic Lower Trapezius Transfer With Tendon Autograft in the Management of Massive Irreparable Posterosuperior Rotator Cuff Tears

Multiple surgical treatment comparisons for irreparable rotator cuff tears: A network meta-analysis

Tendon transfers for irreparable rotator cuff tears

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