scholarly journals Arthroscopic lower trapezius tendon transfer provides equivalent outcomes to latissimus dorsi transfer in the treatment of massive posterosuperior rotator cuff tears

2020 ◽  
Vol 5 (5) ◽  
pp. 269-274
Author(s):  
Jarret M Woodmass ◽  
Eric R Wagner ◽  
Michelle J Chang ◽  
Kathryn M Welp ◽  
Florian Grubhofer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Latissimus Dorsi ◽  
Tendon Transfer ◽  
Adhesive Capsulitis ◽  
Rotator Cuff Tears ◽  
Forward Flexion ◽  
Patient Reported ◽  
Cutibacterium Acnes ◽  
Lower Trapezius

ObjectivesThe purpose of this study is to compare early postoperative recovery following open and arthroscopic-assisted latissimus dorsi tendon (aa-LDT) transfer to arthroscopic-assisted lower trapezius tendon (aa-LTT) transfer for patients with massive irreparable posterosuperior rotator cuff pathology.MethodsA multicentre retrospective analysis comparing the postoperative outcomes after open LDT, arthroscopic-assisted LDT (aa-LDT) or arthroscopic-assisted LTT (aa-LTT) was performed. Active range of motion and patient-reported subjective outcomes were reported preoperatively and postoperatively. Overall, there were 10 patients who underwent open LDT transfer, 16 aaLDT transfers and 8 aa-LTT transfers with mean age of 55±3, 57±6 and 53±13, respectively. Mean follow-up was 22±10 months.ResultsArthroscopic-assisted LDT had significantly improved postoperative forward flexion (85–124, p<0.003) and external rotation (29–38, p<0.005), whereas aa-LTT had significantly improved postoperative forward flexion (101–146, p<0.04). Arthroscopic-assisted LDT and aa-LTT transfers improved American Shoulder and Elbow Surgeons (ASES) Shoulder Function scores and Single Assessment Numeric Evaluation (SANE) at 2 years (p<0.03). Arthroscopic-assisted LTT compared with open LDT demonstrated significantly improved ASES Shoulder Index score (20.0 vs 12.6; 84.8 vs 55.6) and visual analogue scale (VAS) (0.66 vs 4.14; 1.17 vs 3.88) at postoperative 6 months and 2 years, respectively. Arthroscopic-assisted LDT transfer compared with open LDT had improved VAS at 6 months (0.66 vs 2.11, p<0.05). In total, 6 (17.6%) complications were noted. These included two infections with Cutibacterium acnes, two axillary nerve injuries, complex regional pain syndrome and a postsurgical adhesive capsulitis.ConclusionsArthroscopic-assisted LDT and aa-LTT transfers provided improvement in pain and function at 2-year follow-up. The aa-LTT transfer provided significantly improved outcomes at 2 years compared with the open-LDT (latissimus dorsi tendon transfer) transfer. This study demonstrates superiority of arthroscopic-assisted tendon transfer techniques over traditional open techniques while establishing the aa-LTT transfer as a safe and effective alternative in the management of massive irreparable rotator cuff tears.Level of evidenceIV.

scholarly journals Latissimus Dorsi Tendon Transfer with or Without Superior Capsular Reconstruction for Treatment of Irrepairable Rotator Cuff Tears

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0010
Author(s):  
Anthony F. De Giacomo ◽  
Hithem Rahmi ◽  
Sevag Bastian ◽  
Christopher Klein ◽  
John Itamura
Keyword(s):  
Rotator Cuff ◽  
Latissimus Dorsi ◽  
Tendon Transfer ◽  
Rotator Cuff Tears ◽  
Dash Score ◽  
Vas Score ◽  
Superior Capsular Reconstruction ◽  
Significant Difference ◽  
Secondary Outcomes

Objectives: Treatment options for massive irreparable rotator cuff tears, in middle aged adults, consists of tendon transfer or superior capsular reconstruction (SCR). The purpose of this study was to evaluate if transfer of the latissimus dorsi tendon transfer is enhanced with combination of superior capsular reconstruction for treatment of massive irreparable rotator cuff tears. Methods: At a single institution, all consecutive patients undergoing transfer of the latissimus dorsi tendon with or without superior capsular reconstruction, between 2013 and 2016, for treatment of irreparable rotator cuff tears were evaluated. SCR, was indicated, in addition to latissimus transfer, for patients with impaired preoperative active abduction. All clinical notes, diagnostic imaging, and operative reports were reviewed in detail. Demographics, operative techniques, and radiographic parameters were collected and measured. Functional outcome scores were prospectively collected from patients. The primary outcome of the study was the Disability of Arm, Shoulder, Hand (DASH) score. The secondary outcomes of the study were the Visual Analog Scale (VAS) pain score, Single Assessment Numeric Evaluation (SANE) score, and the American Shoulder and Elbow Society (ASES) score. Results: At 3 years, there were a total of 26 latissimus dorsi tendon transfers performed in patients with irreparable rotator cuff tears. Of these, 8 patients underwent only latissimus dorsi tendon transfer and 18 patients underwent latissimus dorsi tendon transfer combined with a superior capsular reconstruction. Average age was 53 years old with the majority of patients being male (88%). The dominant extremity was involved in 22 (85%) of latissimus transfers and 14 (53%) of patients had previous surgery to address a rotator cuff tear. Follow-up, for the entire cohort, was on average 29 months. At final follow-up, there was no significant difference in physical examination or radiographic measurements between patients with latissimus transfer alone and those with latissimus transfer with SCR. All patients, undergoing either technique, showed significant improvement in both the DASH score (preoperative DASH=59.6, postoperative DASH=39.9, P=0.049) and VAS score (preoperative VAS=6.6, postoperative VAS=3.3, P=0.0006). However, those patients undergoing revision surgery, regardless of technique, showed significantly less improvement in the DASH score (P=0.005), VAS score (P=0.002), SANE score (P=0.005), and the ASES score (P=0.001). Transfer of the Latissimus tendon with SCR, in comparison to only tendon transfer, did not show any significant difference in the final DASH score (p-value=0.72). At the same time, there was no significant difference between latissimus transfer, with or without SCR, in the secondary outcomes of the VAS score(P=0.97), the SANE score(P=0.63), or the ASES score (P=0.74). Conclusion: This is the first study to report the outcomes of latissimus dorsi tendon transfer with superior capsular reconstruction in comparison to only latissimus dorsi tendon transfer for treatment of irreparable rotator cuff tears. The study suggests that transfer of the latissimus dorsi tendon in combination with superior capsular reconstruction, at short term follow-up of 2 years, may not significantly influence functional outcome. Rather, patients undergoing revision surgery, regardless of technique, may demonstrate smaller improvements in functional outcomes. [Table: see text][Table: see text]

scholarly journals Latissimus Dorsi Tendon Transfer Vs. Superior Capsular Reconstruction for Treatment of Irreparable Massive Rotator Cuff Tears: A Retrospective Comparison Study with Short-Term Clinical Results

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0038
Author(s):  
Tiffany Kadow ◽  
Daniel Garcia ◽  
Rebecca Minorini ◽  
Mark Baratz ◽  
Ruth Delaney ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Rotator Cuff Tears ◽  
Short Term ◽  
Forward Flexion ◽  
Massive Rotator Cuff Tears ◽  
Superior Capsular Reconstruction ◽  
Patient Reported

Objectives: Irreparable massive rotator cuff tears, particularly those that occur in younger patients, represent a particularly challenging clinical scenario with limited options. Treatments such as reverse total shoulder arthroplasty are typically not well indicated for this patient population. We compared two treatment methods, latissimus dorsi tendon transfer (LDTT) vs arthroscopic superior capsular reconstruction (SCR), to determine if one is superior to the other regarding improvement in range of motion (ROM) and patient reported outcomes (PROs). We hypothesize that both treatments would have similar outcomes regarding functional restoration and subjective outcomes. Methods: A retrospective cohort study assessed 43 patients with an irreparable posterosuperior rotator cuff tear after failed conservative or surgical treatment who underwent either LDTT (14 patients, 16 shoulders) or SCR (27 patients, 27 shoulders). Patients with a minimum of 6 month follow-up were included (mean follow up: 17.9 months, 14.9 months respectively). Changes in preoperative and postoperative forward flexion and external rotation were evaluated. Patient reported outcomes (PROs) including ASES, VAS, and SSV were assessed. T-test and Chi-Square statistical tests were performed. Results: The mean age at the time of surgery was 59.9yo vs 60yo for LDTT and SCR respectively (p=0.98). There were significantly more patients in the LDTT group that had undergone prior rotator cuff surgery (p<0.005) and significantly greater number of patients who had subscapularis tears which required repair in patients that underwent SCR (p<0.01). There was no difference in gender (p=0.75). Both cohorts demonstrated similar improvement in forward flexion with mean active forward flexion improving from 123° (90-160°) pre-operatively to 139° (80-180°) postoperatively in the LDTT group (p=0.157) and 85° (0-170°) preoperatively to 138° (40-175°) postoperatively in the SCR group (p =0.001). The average improvement in forward flexion was significantly greater in the SCR group with an improvement of 52° for SCR vs 14° for LDTT (p=0.035). External rotation improved in the LDTT cohort from 41° preoperatively (10-60°) to 62° (10-80°) (p=0.032) while external rotation stayed unchanged for the SCR cohort with 43° preoperatively (0-70°) to 44° (20-80°) postoperatively (p=0.868). The improvement in external rotation was significantly greater in the LDTT cohort with improvement of 19° vs 0.5° in the SCR group (p=0.011). There was no significant difference in reported ASES scores (LDTT: 65.6 vs SCR:70.9)(p=0.569), VAS (LDTT:1.78 vs SCR 2.26) (p=0.645), or SSV (LDTT:55 vs SCR:72.6) (p=0.087). Conclusion: LDTT and SCR both result in functional improvement of motion with SCR improving forward flexion to a greater extent and LDTT improving external rotation to a greater extent. Patient reported outcomes are similar between the two groups at short term follow up. Longer term outcomes are necessary before determining whether one treatment is optimal over the other as well as establishing the appropriate indications for each. [Table: see text]

Biomechanical Comparison of the Lower Trapezius Transfer Versus Latissimus Dorsi Tendon Transfer for Irreparable Massive Posterosuperior Rotator Cuff Tears

2013 ◽  
Vol 22 (4) ◽  
pp. e26-e28
Author(s):  
Reza Omid ◽  
Nathanael Heckmann ◽  
Lawrence Wang ◽  
Michelle H. McGarry ◽  
C. Thomas Vangsness ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Latissimus Dorsi ◽  
Tendon Transfer ◽  
Rotator Cuff Tears ◽  
Lower Trapezius ◽  
Biomechanical Comparison

Latissimus Dorsi Tendon Transfer for the Treatment of Irreparable Rotator Cuff Tears

2016 ◽  
Vol 21 (4) ◽  
pp. 181
Author(s):  
Jin Soo Park ◽  
Soo Joong Choi ◽  
Kyu Chul Noh ◽  
Seong Yeon Kim ◽  
Hong Kyun Kim ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Latissimus Dorsi ◽  
Tendon Transfer ◽  
Rotator Cuff Tears

LATISSIMUS DORSI TENDON TRANSFER FOR IRREPARABLE POSTEROSUPERIOR ROTATOR CUFF TEARS

2006 ◽  
Vol 88 (2) ◽  
pp. 342-348 ◽  
Author(s):  
JOSEPH P. IANNOTTI ◽  
SHAWN HENNIGAN ◽  
RICHARD HERZOG ◽  
SAMI KELLA ◽  
MARTIN KELLEY ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Latissimus Dorsi ◽  
Tendon Transfer ◽  
Rotator Cuff Tears

scholarly journals Arthroscopic Superior Capsular Reconstruction in Males Provides Superior Outcomes to Reverse Total Shoulder or Debridement for Irreparable Rotator Cuff Tears

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0010
Author(s):  
John M. Tokish ◽  
Michael J. Kissenberth ◽  
Ellen Shanley ◽  
Stefan John Tolan ◽  
Kyle J. Adams ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Patient Reported Outcomes ◽  
Rotator Cuff Tears ◽  
Preliminary Results ◽  
Biceps Tenotomy ◽  
Superior Capsular Reconstruction ◽  
Patient Reported ◽  
Male Patients ◽  
Reverse Total Shoulder

Objectives: Early results following arthroscopic superior capsular reconstruction(SCR) in patients with massive, irreparable rotator cuff tears are promising. However, no studies have compared patient reported outcomes between SCR or reverse total shoulder(rTSA) and rotator cuff debridement for these patients. Therefore, the purpose of this study was to compare 1-year outcomes between patients with massive irreparable rotator cuff tears who underwent a SCR, rTSA, or rotator cuff debridement with a concurrent biceps tenotomy or tenodesis. Methods: Patients(n=63) who underwent either SCR(n=21), rTSA(21), or cuff debridement(n=21) and biceps tenotomy or tenodesis for a massive, irreparable rotator cuff tear treated with a minimum 1-year follow up were retrospectively reviewed. Age, sex, BMI, smoking status, Charlson Index, Hamada classification, and ASES scores were recorded and compared using a multivariate ANOVA were used to compare between surgical approaches. A Chi Square analyses were used to compare sex distribution and the Charlson Deyo Index between groups (α=0.05). Results: Overall, patients across the 3 groups were not statistically different in age or follow up ASES score at minimum 14 month follow up ( P> 0.05). There was a significant interaction effect between surgery group and sex (P=0.02) on ASES score but not age ( P=0.08). Univariate F tests revealed that male patients who received an SCR displayed a 10-14% better outcome at follow up compared to other groups (Table 1) which exceeds the reported ASES score MCID. Conclusion: Our results show comparable results across surgical options for massive irreparable cuff tears with good patient reported outcomes. Male patients displayed clinically important greater ASES scores at 1 year follow up. Future studies should evaluate these preliminary results to assess if these preliminary results hold up at longer follow up times.

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