Reverse Total Shoulder Arthroplasty with Concurrent Latissimus Dorsi Tendon Transfer

Abstract

Purpose of Review Reverse total shoulder arthroplasty (rTSA) has emerged as an effective treatment option for patients with rotator cuff arthropathy resulting from irreparable rotator cuff tears. However, patients with combined loss of abduction and external rotation may still experience functional deficits after rTSA. One option to address this has been the latissimus dorsi tendon transfer (LDTT), or modified L'Episcopo procedure. The purpose of this review is to describe the role of LDTT with rTSA and to critically evaluate the evidence on whether a supplemental LDTT ultimately improves patient function.Recent Findings Patients with an intact rotator cuff demonstrated a significant increase in active external rotation following rTSA compared to those with a deficient rotator cuff following rTSA. Compared to their pre-operative baseline assessments, patients who undergo rTSA with LDTT report significant improvements in active external rotation. However, a randomized trial comparing rTSA patients with and without LDTT failed to demonstrate a significant difference in active external rotation or patientreported outcomes between groups. Summary Observational studies have shown that patients experience significant improvements in active range of motion and various patient-reported outcome measures following rTSA with latissimus dorsi tendon transfer. When directly comparing rTSA with LDTT to rTSA alone, the current literature fails to demonstrate a statistically significant difference in active external rotation or patient-reported outcomes at short-term follow-up. Further randomized controlled trials are required to fully understand the potential benefits of added tendon transfer in the rTSA patient population.

Birth Injury, Duchenne-Erbʼs Obstetric Palsy. Diagnosis and Treatment (Literature Review)

“…Later, microsurgical techniques were supplemented with transposition of free muscle grafts and vascularized nerve grafts [49][50][51]. At the end of the 1990s, quite a lot was published about the technique of transposition of the phrenic and contralateral S VII nerves [44][45][46][47][48][49][50][51][52][53].…”

“…J. Sever eliminated the intra-rotator contracture by releasing the pectoralis major and minor muscles and the subscapular muscle without capsulotomy of the shoulder joint [51], and J. L'Episcopo demonstrated the release of the subscapular muscle with transposition of the teres major, and later, the broadest muscle of the back to the posterior edge of the capsule of the shoulder joint with transaxial fixation [52]. R. Zachary described the technique of transposition of the latissimus dorsi muscle and teres major in the position of the external rotators of the shoulder [53].…”

Clinical and functional outcomes of reverse total shoulder arthroplasty supplemented with latissimus dorsi transfer: a systematic review and meta-analysis

“…However, for patients with CLEER, resolution of external rotation deficits postoperatively has not been satisfactory or predictable. 22 Because of this, latissimus dorsi transfer during RTSAs is performed to theoretically improve postoperative external rotation in patients with CLEER. The purpose of our study was to evaluate the effects of latissimus dorsi transfer with RTSAs for patients with CLEER regarding elevation and external rotation.…”

Applications of Latissimus Dorsi Grafts in Reverse Shoulder Arthroplasty

“…The tendon is then tied to the rotator cuff muscles, which are not torn or damaged, and the sutures are tightened against the bones of the shoulder joint. The flaps are then closed in the back and at the front end [31,32].…”

“…The range of movements include external rotation and abduction. The benefits of using an arthroscopically assisted approach include avoiding detachment of the deltoid muscle from its point of origin, smaller incisions, and the ability to address any additional intraarticular issues [8,32,33,36].…”