Results of latissimus dorsi tendon transfer for irreparable cuff tears

Abstract

Rupture of the supraspinatus and infraspinatus tendon (and teres minor) can cause loss of active external rotation (ER), entailing severe functional disability in daily activities. Latissimus dorsi tendon transfer (LDTT), proposed by Gerber in 1988, appears to be the best adapted solution in these cases of irreparable posterior and superior cuff tears. Between 2001 and 2004, 30 patients were operated on by the technique described by Gerber, with the transfer fixed anteriorly to the subscapularis tendon and laterally to the greater tuberosity by transosseous suture. One patient, subsequently requiring revision with a reversed prosthesis, was considered as a failure. Twenty-six patients were reviewed with a mean follow-up delay of 34+/-12 months. There were 14 men and 13 women. Mean age was 55.5 years (36 to 71 years). Preoperatively, active ER was symmetric in seven cases, loss of active ER was moderate with positive lag sign in five cases, significant with positive dropping sign in six cases, and severe in nine cases. Fatty muscular degeneration was present and significant in all cases for the infraspinatus muscle and in 14 cases for the teres minor muscle (associated with significant ER loss). Subjectively, 85% of the patients were very satisfied or satisfied and the Subjective Shoulder Value (SSV) was 68+/-17%. The pain score improved from 4.8+/-3 preoperatively to 12.2+/-2 postoperatively, strength from 3.7+/-2 kg to 4.2+/-1.8 kg, mean Constant score from 50+/-12 to 74+/-9, and Constant score adjusted for age and gender from 62+/-15% to 91+/-11%. Mean active ER gain was 7 degrees (-30 degrees to +50 degrees). The loss of active ER was aggravated in one case, unchanged in three, improved in nine and corrected in six. Hornblower sign was corrected in six cases and persisted in nine. Postoperatively, 8% of the patients were unable to eat and drink, compared to 64.7% preoperatively. The results of this series are comparable to those found in the literature for first-intention cases. LDTT restored active ER, but the results were incomplete and variable. Improvement was better in case of severe preoperative active ER deficit and insufficiency of the teres minor muscle. Recovery of strength was not observed in the present series. A narrow subacromial space and grade-3 Hamada classification had negative impact. In spite of an expected tenodesis effect, LDTT did not recenter the humeral head. LDTT compensates the deficient teres minor muscle rather than the infraspinatus muscle. The optimal indication for LDTT is irreparable superior and posterior rotator cuff rupture with loss of active ER associated with a deficient teres minor muscle. It is debatable whether LDTT is indicated in the absence of active motion deficiency: improvement was observed in these cases, but only in terms of subjective criteria.

Partial repair of irreparable supraspinatus tendon tears: clinical and radiographic evaluations at long-term follow-up

“…With internal rotation, 9 of 14 treated patients showed slightly improved positioning of the humeral head in relation to the glenoid. 37,49 Conclusions This study indicates that, in cases of massive RCT with no subscapularis tear, long-term results of partial repair of the posterior cuff with covering of the infraspinatus footprint showed improved outcome scores. In addition, AHD increased minimally and was stable at final followup.…”

Massive rotator cuff tear treated with a synthetic patch: a case report 16 years after surgery

“…Novè-Josserand [21] reported that of 30 patients treated, all presented recovery of external rotation and disappearance of the hornblower sign, 8% of the patients were still unable to use the operated limb to eat and drink, compared with 64.7% before surgery. Zafra [22] treated 8 patients with this technique and reported pain relief and improved mobility in external rotation in 88.8%.…”

A Radiographic Classification of Massive Rotator Cuff Tear Arthritis

“…Furthermore, there appeared to be a correlation between the modified classification of Walch et al and the Constant-Murley score [6] in 200 patients aged 70 to 101 years [21]. This modified classification has been used for selecting candidates for latissimus dorsi transfer [20].…”