The latissimus dorsi tendon functions as an external rotator after arthroscopic-assisted transfer for massive irreparable posterosuperior rotator cuff tears

Abstract

Purpose Latissimus dorsi tendon transfer is a surgical option for the treatment of massive irreparable posterosuperior rotator cuff tear. Whether a favourable clinical outcome is due to the latissimus dorsi muscle contraction rather than the passive tenodesis effect remains to be confirmed. The purpose of the current case–control study was to evaluate the shoulder kinematics and latissimus dorsi activation after latissimus dorsi tendon transfer. Methods Eighteen patients suffering from irreparable rotator cuff tear that underwent latissimus dorsi tendon transfer and 18 healthy individuals were examined using a 3D kinematic tracking system and electromyography. Active maximal flexion–extension and abduction–adduction of the humerus were measured for the operated and the contralateral shoulder of the patients and the shoulder of healthy individuals to evaluate the range of motion (ROM) and scapulohumeral rhythm. Electromyographic comparison of isometric contraction between the latissimus dorsi of the operated and contralateral shoulder was carried out. Results After arthroscopic‐assisted latissimus dorsi tendon transfer, patients showed comparable flexion and abduction ROM to their asymptomatic contralateral shoulders and to the shoulders of healthy individuals. Significantly higher scapular ROM values were found between the latissimus dorsi tendon transfer side and the shoulders of healthy individuals. While performing external rotation with 0° shoulder abduction, a greater percentage of the electromyographic peak value (p = 0.047) and a higher latissimus dorsi internal/external rotation ratio (p = 0.004) were noted for the transferred muscle in comparison to the contralateral shoulder. Conclusion Although the arthroscopic‐assisted latissimus dorsi tendon transfer failed to normalize scapulothoracic joint movements of patients, a functional latissimus flap and a shoulder ROM similar to the contralateral side or the shoulder of healthy individuals can be expected after this procedure in patients with massive irreparable posterosuperior rotator cuff tear. Level of evidence III.

Early Efficacy Assessment of Arthroscopic Lower Trapezius Transfer With Tendon Autograft in the Management of Massive Irreparable Posterosuperior Rotator Cuff Tears

“…For irreparable PSRCT, previous studies reported the theoretical improvement of the external rotation after LDT, rebalancing the force couple of infraspinatus and teres minor muscles, as well as its ability to depress the humeral head (19), while other studies showed only suboptimal improvement. The electromyographic response in the transferred latissimus dorsi muscle was stronger during adduction than during external rotation (20), and more rehabilitation and adaptation are required for better synergic movement of latissimus dorsi tendon (21). Retear after latissimus dorsi transfer was also reported in some patients (22,23).…”

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

“…The allarthroscopic technique may have the main disadvantage that an appropriate release of the latissimus dorsi muscle belly is difficult, making it almost impossible to transfer the tendon to the desired fixation point at the anterior part of the greater tuberosity and leading to a high tension at the tendon-to-bone fixation interface. In contrast, the arthroscopically assisted LDT allows for an appropriate latissimus dorsi release and offers some potential benefits over the open technique such as the iatrogenic deltoid insufficiency can be avoided 18 ; the remaining posterosuperior rotator cuff as well as subscapularis lesions can be detected and effectively repaired; and the passage of the tendon between the posterior deltoid muscle and the teres minor can be visualized and *Data are presented as mean ± standard deviation. a Elongation at failure indicates the amount of device elongation which occurred until the ultimate load to failure was reached.…”

Superior Capsular Reconstruction Versus Lower Trapezius Transfer for Posterosuperior Irreparable Rotator Cuff Tears With High-Grade Fatty Infiltration in the Infraspinatus

“…The ASES score is a standardized and validated measure for assessing shoulder pain, level of daily activities, and function. Patient satisfaction was evaluated on a 10-point scale as follows: unsatisfied (1-4), satisfied (5-7), and very satisfied (8)(9)(10).…”