Risk of latissimus dorsi tendon rupture after arthroscopic transfer for posterior superior rotator cuff tear: a comparative analysis of 3 humeral head fixation techniques

Kany, Jean; Sekaran, Padmanaban; Grimberg, Jean; Amavarathi, Rajkumar S.; Valenti, Philippe; Elhassan, Bassem T.; Werthel, Jean David

doi:10.1016/j.jse.2019.06.019

Cited by 21 publications

(28 citation statements)

References 31 publications

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“…The rate of LD rupture was 38%, 27%, and 15% in the groups, respectively. 2,22 Thus we now fix the tendons flat at the junction between SS and IS to prevent overtensioning and the killer turn "guillotine" effect with subsequent tendon rupture.…”

Section: Discussionmentioning

confidence: 99%

“…The combined LD/TM transfer is fixed with appropriate tension at the junction between supraspinatus and infraspinatus foot prints in neutral rotation of the arm using 2 knotless anchors (Versa lock, Mitek) with the blue/white suture medially and the green/white suture laterally to prevent any twist and to fix it flat onto the footprint of the IS (Fig 8). 22…”

Section: Fixation Of Ld/tm To the Humeral Headmentioning

confidence: 99%

“…[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. 23 Finally, LD alone could not be strong enough to rebalance the shoulder posteriorly especially in case of 2 or 3 ruptured tendons (supraspinatus [SS], infraspinatus [IS], TM) because, according to the rules of tendon transfers, 1 transfer can supply for 1 tendon only.…”

mentioning

confidence: 99%

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

Kany

Selim

2020

Arthroscopy Techniques

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Many treatment options have been proposed for treatment of irreparable posterosuperior rotator cuff tears. Among these options, latissimus dorsi tendon transfer can be considered a good alternative, especially in young patients before development of glenohumeral arthritic changes, aiming at rebalancing the shoulder with a functioning subscapularis muscle and restoring both active external rotation and elevation with the aid of a properly functioning deltoid muscle. The technique was recently adapted from open to arthroscopically assisted with numerous advantages. We propose a combined fully arthroscopic technique for transfer of latissimus dorsi and teres major in which the tendons are fixed in a flat manner at the junction of supraspinatus and infraspinatus to decrease failure rate.

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Section: Discussionmentioning

confidence: 99%

Section: Fixation Of Ld/tm To the Humeral Headmentioning

confidence: 99%

mentioning

confidence: 99%

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

Kany

Selim

2020

Arthroscopy Techniques

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“…It is a modification of a previously described technique which aims to provide more reliable bone-bone healing and address the issue of guillotine-type failure that can occur at the tendon graft-humeral interface, when a tendon is tubularized and inserted into a transosseous tunnel ( Table 2 ). 13 , 14 , 15 …”

Section: Discussionmentioning

confidence: 99%

“…This site of reinsertion to a more posterior location probably decreases the tension applied to the transferred tendon and therefore facilitates healing. 15 …”

Section: Discussionmentioning

confidence: 99%

Arthroscopic-Assisted Lower Trapezius Tendon Transfer for Massive Irreparable Posterosuperior Rotator Cuff Tears Using an Achilles Tendon-Bone Allograft

Lording²,

McBride³

2020

Arthroscopy Techniques

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The lower trapezius tendon (LTT) transfer has been described for the management of irreparable posterosuperior rotator cuff tears. Here we describe our technique of an arthroscopic-assisted LTT transfer using an Achilles tendon-bone allograft. This technique allows for augmentation of the tendon transfer using an Achilles tendon allograft while also keeping the calcaneal bone insertion, which allows for added bony fixation into the humerus and also minimizing the risk of the "killer turn" phenomenon at the aperture of fixation.

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Biomechanical analysis of arthroscopically assisted latissimus dorsi transfer fixation for irreparable posterosuperior rotator cuff tears—Knotless versus knotted anchors

Ernstbrunner

Borbas

Rohner

et al. 2020

Journal Orthopaedic Research

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We compared the construct stability of traditional knotted techniques with modern knotless anchor systems used in arthroscopically assisted latissimus dorsi transfers (aLDTs) for irreparable posterosuperior rotator cuff tears. Eighteen cadaveric shoulders were age-and gender-matched to the following three groups: knotted group (two knotted anchors); knotless group (two knotless anchors); and triple anchor group (two knotless anchors; one all-suture anchor at the apex of the humeral head). All tendons were cyclically loaded in line of the aLDT over 400 cycles followed by a load to failure test. Outcome measures were the ultimate load to failure, elongation, construct stiffness, and failure modes. The triple anchor group revealed the highest ultimate load to failure (431 ± 78 N) compared with the knotted (326 ± 52 N; p = .022) and knotless (353 ± 105 N; p = .129) groups. Total elongation and construct stiffness were not significantly different comparing all three groups. The failure modes were: anchor pull-out in all specimen of the knotted group; three (50%) anchor pull-out and three suture pull-out in the knotless group (p = .046); four (67%) anchor pull-out, one (17%) suture pull-out and one tendon pull-out in the triple anchor group. Biomechanical analyses of knotless fixation techniques for aLDTs show similar construct stability and elongation compared with the traditional, knotted techniques. Bone fixation seems to be improved with the knotless anchor systems. In our practice, we continue to use the knotless fixation technique for aLDT and in the situation of weak, osteoporotic bone, we add a third (all-suture) anchor to improve construct stability.

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Risk of latissimus dorsi tendon rupture after arthroscopic transfer for posterior superior rotator cuff tear: a comparative analysis of 3 humeral head fixation techniques

Cited by 21 publications

References 31 publications

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

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

Arthroscopic-Assisted Lower Trapezius Tendon Transfer for Massive Irreparable Posterosuperior Rotator Cuff Tears Using an Achilles Tendon-Bone Allograft

Biomechanical analysis of arthroscopically assisted latissimus dorsi transfer fixation for irreparable posterosuperior rotator cuff tears—Knotless versus knotted anchors

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