Management of Massive Rotator Cuff Tears: Prospective study in 218 patients

Combined Fully Arthroscopic Transfer of Latissimus Dorsi and Teres Major for Treatment of Irreparable Posterosuperior Rotator Cuff Tears

“…1 A prospective study performed by the French Arthroscopic Society on 218 patients with massive RCTs reported a 43% rupture rate in patients treated with arthroscopic latissimus dorsi transfer. 3 We have reported a 38% postoperative rupture rate at 2 years' follow-up of 60 patients treated with arthroscopicassisted LD tendon transfer for irreparable posterosuperior cuff tears in whom the tubularized LD tendons were fixed in a bone tunnel inside the humeral head. The outcome of LD tendon transfer is significantly lower in those with rupture compared with those without rupture 1 We have also compared the effect of the LD tendon fixation technique to the humeral head on the rates of postoperative tendon rupture.…”

“…The dissection has to be performed until seeing the LD muscle belly (the LD tendon length is about 7-8 cm). 2,3 It is possible to control both pedicles of the TM (6-7 cm from the humeral side) and that of the LD (more distal and more medial; 10-13 cm from the humeral side) at the upper edge of the muscle bellies from the apex of the scapula without any axillary incision. 2,3 Then, the combined tendons of LD/TM are pulled back through the omotricipital triangular space in the previously prepared pathway with the blue/white suture marking the upper border and the green/white suture marking the lower border (Figs 6 and 7).…”

“…Irreparable tears can be also defined as stage 3 tendon retraction according to Patte, stage 3 or 4 fatty infiltration as described by Goutallier et al, stage 3 muscle atrophy according to Thomazeau et al, or superior escape of the humeral head with a subacromial distance <6 mm, Hamada stage 3 with acetabulization of the acromion, failed previous cuff repair, or inability to anatomically repair the cuff after full arthroscopic release. [2][3][4][5] Pseudo-paralytic shoulder was redefined by Burks et al 2,6 as the association of a normal passive range of motion (no stiffness) with no active forward flexion (FF; <45 ) or limited active external rotation and/or internal rotation. 2 Many treatment options have been proposed to manage irreparable RCT including debridement with subacromial bursectomy 7 and/or tenotomy or tenodesis of the long head of the biceps, 8,9 partial repair of the residual cuff, 10 deltoid flap, 11 lower trapezius transfer, 12 latissimus dorsi (LD) transfer, 13 reverse shoulder arthroplasty, 14 and the interposition of a subacromial spacer 15 or superior capsule reconstruction.…”

“…2,6,20 Many different techniques have been described ranging from open to mini-open to fully arthroscopic techniques, perhaps with tendon or bony augmentation 21 ; however, there was still high rate of transferred LD rupture (38% to 43%). [1][2][3] Such a high rate of rupture may be explained by the weakness of the LD tendon or too high a tension after reinsertion of a tubularized tendon into the bone (guillotine effect) in over-the-top position. 22 Moreover, it is difficult to separate and harvest LD from TM because of very close anatomical connections.…”

Reverse Shoulder Arthroplasty for Massive Rotator Cuff Tears

“…Oudet et al [122] in 2017 participated in a multicenter study proposed by the Arthroscopic French Society. 218 patients were enrolled in this prospective, non randomized study comparing different treatments including patients presenting a MCT (2 tendons minimum with a fatty degeneration > 2): medical, partial cuff repair, isolated tenotomy of the biceps, latissimus dorsi transfer and RSA (36 patients).…”