Modified L'Episcopo Tendon Transfers for Irreparable Rotator Cuff Tears: 5-year Followup

Abstract

Patients with posterosuperior cuff tears lose functional external rotation of the shoulder. Latissimus dorsi and teres major transfer is performed to restore external rotation. Twenty patients with a mean age was 55.8 ± 6 years underwent this procedure and were examined at averages of 24.7 (n = 17) and 70.6 (n = 13) months. Two patients did not improve presumably because of failure of the transfer. The Constant and Murley score increased from 55.6 to 90.4 after 2 years and to 87.9 after 5 years. The mean active flexion increased from 119.4°to 169.3°and reached 170°after 5 years, and mean external rotation increased from 12°to 35°, finally reaching 23°.

Results of Arthroscopic Partial Repair of Large Retracted Rotator Cuff Tears

“…Because muscle atrophy and fatty infiltration cannot be reversed without continuous distraction 20,21 and are known to progress even after partial rotator cuff repair, this could be one factor affecting the external rotation weakness found in our patients. Conversely, one may conclude that the mean postoperative level of external rotation evaluated (36 ) in our series is comparable to the results found 5 years after combined latissimus dorsi/teres major transfer for irreparable posterosuperior tears 22 and therefore presents an adequate result. At least a persisting suprascapular nerve neuropathy caused by traction from an incomplete rotator cuff repair may have been a reason for persisting external rotation weakness.…”

Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes

“…121 Clinical outcomes Studies regarding the clinical outcomes of latissimus dorsi tendon transfers are summarized in Supplementary Table III. 3,15,20,23,26,29,41,[43][44][45]61,62,75,89,92,98,116,121,122 A systematic review conducted by Namdari et al analyzed 10 studies between 1992 and 2010 to determine the expected outcomes, predictive factors for success, and complications of latissimus dorsi transfers. 94 Frequency-weighted mean follow-up was 45.5 months.…”

Latissimus Dorsi Transfer in Posterior Irreparable Rotator Cuff Tears

“…[55] noted structural deterioration comparable to non-operative management, although progression was reported slower. The described osteoarthritic changes were commonly restricted in 1 or 2 stages of the Hamada classification [82], while another group [130] reported significant osteoarthritic changes with time. However, it has been reported that radiologic findings regarding arthritic degeneration are not related to the clinical outcomes [43, 54, 117].…”

“…However, it has been reported that radiologic findings regarding arthritic degeneration are not related to the clinical outcomes [43, 54, 117]. Nevertheless joint degeneration is anticipated [43, 75, 117] due to degradation of the tenodesis effect over time [131], a finding evident in several studies that demonstrated a decrease in acromiohumeral distance in the mid [130] and long term [55, 127] in comparison to the initial postoperative outcome. It has been suggested however, that potentially LD tendon transfer may prolong the time till arthroplasty [131].…”