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Salazar-Méndez J, Morales-Verdugo J, Lluch-Girbés E, Araya-Quintanilla F, Ribeiro IL, Mendoza-Grau R, Mellado-Méndez J, Mendez-Rebolledo G. A scoping review of tendon transfer surgeries and postsurgical physical therapy interventions in individuals with massive rotator cuff tears. PM R 2024; 16:745-765. [PMID: 37870114 DOI: 10.1002/pmrj.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/18/2023] [Accepted: 10/02/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To identify tendon transfer surgeries and postsurgical physical therapy interventions in people with massive rotator cuff (RC) tears. METHODS The literature search was conducted in the MEDLINE, Science Direct, Scopus, Web of Science, and PEDro databases from inception to September 2022. Studies with patients diagnosed with massive RC tears undergoing tendon transfers that reported physical therapy interventions after surgery were included. Two reviewers pooled the data into ad hoc summary tables with the following information: authors, year, study characteristics (sample size, tendon transfer surgical used, approach type, preoperative risk, deficit addressed, additional surgical interventions), and physical therapy interventions (early stage, intermediate stage, and advanced stage). RESULTS Forty-four articles (59.0% case series) were included, with a total sample of 1213 participants. The most frequently used surgery was the isolated tendon transfer of the latissimus dorsi (49.1%). Most of the studies reported three main stages of physical therapy interventions after tendon transfer surgery: early stage (lasting 5-6 weeks), intermediate stage (started at 7-12 weeks), and advanced stage (started at 12 weeks). Physical therapy interventions included passive, active-assisted, resisted therapeutic exercise, and hydrotherapy. CONCLUSIONS The evidence regarding physical therapy interventions after RC tendon transfer surgery is limited to the number and duration of the stages and general characteristics without specifying the type and dose of the interventions. Future research with high methodological quality should integrate more detailed rehabilitation protocols to better guide therapeutic decisions after RC transfer surgery.
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Affiliation(s)
- Joaquín Salazar-Méndez
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Juan Morales-Verdugo
- Departamento de Ciencias Preclínicas, Facultad de Medicina, Universidad Católica del Maule, Talca, Chile
| | - Enrique Lluch-Girbés
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Felipe Araya-Quintanilla
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
| | - Ivana Leao Ribeiro
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | | | | | - Guillermo Mendez-Rebolledo
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
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Sánchez Cruz DA, Mosquera M, Rossi LA, Patiño P, Ikemoto RY, Miguel JR, Valero-González FS, Vargas C P, Lozano CM, Llinás H PJ. Latin American formal consensus on the indications for the surgical treatment of massive and irreparable rotator cuff tears. J ISAKOS 2024; 9:160-167. [PMID: 38184073 DOI: 10.1016/j.jisako.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
OBJECTIVES To implement the Formal Consensus Method among a group of experts in shoulder surgery in Latin America, in order to establish appropriate indications for the surgical treatment of massive and irreparable rotator cuff injuries. METHODS The Formal Consensus Method was used to develop surgical treatment recommendations for massive and irreparable rotator cuff tears (MIRCT). Three independent groups of experts in shoulder surgery were confirmed. The steering group conducted a systematic literature review and constructed a voting matrix consisting of 348 clinical scenarios. The rating group, composed of 15 members, rated each scenario on two occasions: first anonymously and then during an in-person discussion meeting. The median and voting ranges were used to classify each scenario as inappropriate, uncertain, or appropriate for each surgical technique. Finally, the reading group, consisting of 10 surgeons, reviewed, evaluated and rated the recommendations derived from the detailed analysis of the voting grids. RESULTS The main finding of the study reveals a high percentage (70%) of clinical scenarios in which consensus was achieved regarding the appropriateness or inappropriateness of different surgical alternatives for the treatment of massive and irreparable rotator cuff injuries. Through a detailed analysis of the voting grids, a total of 20 recommendations were elaborated concerning the appropriateness of various surgical techniques in addressing irreparable rotator cuff tears. CONCLUSIONS The indications for the operative treatment of MIRCT were determined based on expert consensus and the best available evidence, they seek to provide guidance on the appropriateness of various surgical techniques for different clinical scenarios. LEVEL OF EVIDENCE V.
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Affiliation(s)
| | | | - Luciano A Rossi
- Hospital Italiano de Buenos Aires, Buenos Aires, C1199ABB, Argentina.
| | - Paul Patiño
- Clínica Foianini, Artrocentro, Santa Cruz de la Sierra, 6R54+23, Bolivia.
| | - Roberto Yukio Ikemoto
- Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000 - Santo André/SP, 09060-870, Sao Paulo, Brazil.
| | | | | | | | | | - Paulo J Llinás H
- Hospital Universitario Fundación Valle de Lili, Cali, 760026, Colombia.
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Kany J, Siala M, Werthel JD, Grimberg J. Full arthroscopic vs. arthroscopically assisted posterosuperior latissimus dorsi tendon transfer for shoulders with failed and irreparable rotator cuff repair: matched case-control study. J Shoulder Elbow Surg 2024; 33:e198-e207. [PMID: 37769869 DOI: 10.1016/j.jse.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To compare clinical outcomes and complication rates of full arthroscopic latissimus dorsi tendon transfer (LDTT) vs. arthroscopically assisted LDTT, for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs) in shoulders that had failed rotator cuff repair (RCR). METHODS We evaluated a continuous series of 191 patients who underwent LDTT over 4 consecutive years. A total of 107 patients did not have previous shoulder surgery, leaving 84 patients who had prior surgical procedures. All procedures performed over the first 2 years were arthroscopically assisted (n = 48), whereas all procedures performed over the last 2 years were full arthroscopic (n = 36). We noted all complications, as well as clinical scores and range of motion at ≥24 months. To enable direct comparison between the 2 techniques, propensity score matching was used to obtain 2 groups with equivalent age, sex, and follow-up. RESULTS Compared with the 48 patients who underwent arthroscopically assisted LDTT, the 36 patients who underwent full arthroscopic LDTT had comparable complications (13% vs. 11%) and conversions to RSA (8.3% vs. 5.6%). Propensity score matching resulted in 2 groups, each comprising 31 patients, which had similar outcomes in terms of clinical scores (except mobility component of Constant score, which was better following fully arthroscopic LDTT; P = .037) and range of motion at a minimum follow-up of 2 years. CONCLUSION At a minimum follow-up of 24 months, for the treatment of irreparable posterosuperior mRCTs in shoulders that had surgical antecedents, full arthroscopic LDTT had significantly better mobility component of the Constant score than arthroscopically assisted LDTT, although there were no significant differences in the other clinical or functional outcomes. Arthroscopically assisted LDTT and full arthroscopic LDTT had comparable rates of complications (8.3% vs. 13%) and conversion to RSA (5.6% vs. 8.3%).
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Affiliation(s)
- Jean Kany
- Clinique De l'Union, Ramsay Santé, Saint Jean, France
| | - Mahdi Siala
- Clinique De l'Union, Ramsay Santé, Saint Jean, France
| | | | - Jean Grimberg
- LIRCOS, Clinique Jouvenet, Ramsay Santé, Paris, France
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Velasquez Garcia A, Nieboer MJ, de Marinis R, Morrey ME, Valenti P, Sanchez-Sotelo J. Mid- to long-term outcomes of latissimus dorsi tendon transfer for massive irreparable posterosuperior rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 2024; 33:959-974. [PMID: 37993088 DOI: 10.1016/j.jse.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/20/2023] [Accepted: 10/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND This study aims to analyze the mid-to long-term results of the latissimus dorsi tendon for the treatment of massive posterosuperior irreparable rotator cuff tears as reported in high-quality publications and to determine its efficacy and safety. METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and EMBASE databases were searched until December 2022 to identify studies with a minimum 4 year follow-up. Clinical and radiographic outcomes, complications, and revision surgery data were collected. The publications included were analyzed quantitatively using the DerSimonian Laird random-effects model to estimate the change in outcomes from the preoperative to the postoperative condition. The proportion of complications and revisions were pooled using the Freeman-Tukey double arcsine transformation. RESULTS Of the 618 publications identified through database search, 11 articles were considered eligible. A total of 421 patients (432 shoulders) were included in this analysis. Their mean age was 59.5 ± 4 years. Of these, 277 patients had mid-term follow-up (4-9 years), and 144 had long-term follow-up (more than 9 years). Postoperative improvements were considered significant for the following outcome parameters: Constant-Murley Score (0-100 scale), with a mean difference (MD) = 28 points (95% confidence interval [CI] 21, 36; I2 = 89%; P < .001); visual analog scale, with a standardized MD = 2.5 (95% CI 1.7, 3.3; P < .001; I2 = 89%; P < .001); forward flexion, with a MD = 43° (95% CI 21°, 65°; I2 = 95% P < .001); abduction, with a MD = 38° (95% CI 20°, 56°; I2 = 85%; P < .01), and external rotation, with a MD = 8° (95% CI 1°, 16°; I2 = 87%; P = .005). The overall reported mean complication rate was 13% (95% CI 9%, 19%; I2 = 0%), while the reported mean revision rate was 6% (95% CI: 3%, 9%; I2 = 0%). CONCLUSIONS Our pooled estimated results seem to indicate that latissimus dorsi tendon transfer significantly improves patient-reported outcomes, pain relief, range of motion, and strength, with modest rates of complications and revision surgery at mid-to long-term follow-up. In well-selected patients, latissimus dorsi tendon transfer may provide favorable outcomes for irreparable posterosuperior cuff tears.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Clinica Universidad de los Andes, Santiago, Chile
| | - Micah J Nieboer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rodrigo de Marinis
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile; Shoulder and Elbow Unit, Hospital Dr. Sótero del Rio, Santiago, Chile
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Baek CH, Kim BT, Kim JG, Kim SJ. Joint-preserving treatment for global irreparable rotator cuff tears: combined anterior Latissimus dorsi and Teres major tendon transfer. Arch Orthop Trauma Surg 2024; 144:1473-1483. [PMID: 38285220 DOI: 10.1007/s00402-023-05196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Treating global irreparable rotator cuff tears (GIRCTs) that involve both antero-and postero-superior cuff tendon tears could be a challenging problem. There has been limited joint-preserving treatment options in high-demand patients with minimal glenohumeral arthritis. The study aims to assess the clinical outcome of combined anterior latissimus dorsi and teres major tendon (aLDTM) transfer for patients with both GIRCTs and minimal glenohumeral arthritis. MATERIALS AND METHODS This retrospective study included patients who underwent combined aLDTM transfer for GIRCTs between 2018 May and 2020 October. Clinical outcomes include pain VAS, Constant, American Shoulder and Elbow Society (ASES), University of California Los Angeles (UCLA), activities of daily living requiring active internal rotation (ADLIR) score, active range of motion (aROM), strength, rates of pseudoparalysis or pseudoparesis reversal and return to work. Radiographic assessment included the acromiohumeral distance (AHD), Hamada grade, and transferred tendon integrity at final follow-up. RESULTS 23 patients (mean age: 64.7 ± 5.9 years [55-74]) were included and the mean follow-up period was 28.2 ± 4.3 [24‒36] months. Postoperatively, VAS, Constant, ASES, UCLA, and ADLIR scores significantly improved at final follow-up (P < .001). Postoperative aROM was significantly improved in forward elevation (FE) to 129° ± 29°, abduction (ABD) to 105° ± t3°, and internal rotation (IR) at back to 5.9 ± 2.5. Strength of both FE and IR were also significantly improved (P < .001). Patients with preoperative pseudoparalysis (2 of 4 patients) and pseudoparesis (6 of 6 patients) experienced a reversal. No significant change in AHD and hamada grade was confirmed at final follow-up. 3 patients experienced partial tear of the transferred tendon. CONCLUSIONS In this study, we found significant improvement in clinical outcomes with no significant progression of arthritis by final follow-up. The aLDTM transfer could be an alternative choice of joint-preserving treatment option for young and active patients with GIRCTs and minimal glenohumeral arthritis. However, large and long-term studies should be conducted to establish its adequacy. STUDY DESIGN Case series. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea.
| | - Bo Taek Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea
| | - Seung Jin Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea
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Mercurio M, Castricini R, Castioni D, Cofano E, Familiari F, Gasparini G, Galasso O. Response to Lievano regarding: "better functional outcomes and a lower infection rate can be expected after superior capsular reconstruction in comparison with latissimus dorsi tendon transfer for massive, irreparable posterosuperior rotator cuff tears: a systematic review". J Shoulder Elbow Surg 2024; 33:e44-e47. [PMID: 37774833 DOI: 10.1016/j.jse.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/19/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, "Villa Verde" Hospital, Fermo, Italy; Department of Orthopaedic and Trauma Surgery, "Villa Maria Cecilia" Hospital, Cotignola, Italy
| | - Davide Castioni
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy; Department of Orthopedic and Trauma Surgery, Girolamo Fracastoro Hospital, Verona, Italy
| | - Erminia Cofano
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy.
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
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Kuan FC, Shih CA, Su WR, Garcia AV, Kuroiwa T, Iida N, Hsu KL. Definition of irreparable rotator cuff tear: a scoping review of prospective surgical therapeutic trials to evaluate current practice. BMC Musculoskelet Disord 2023; 24:952. [PMID: 38066535 PMCID: PMC10704799 DOI: 10.1186/s12891-023-07067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The definition of irreparable rotator cuff tear (IRCT) is controversial. This scoping review provides definitions used to describe IRCT in the literature. This scoping review (1) identified criteria used in the definition of IRCT and (2) investigated the current state of those criteria in prospective surgical therapeutic trials. METHODS This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, Scopus, and Web of Science were searched in March 2023. Studies were screened against predetermined inclusion and exclusion criteria. Criteria regarding clinical symptoms, preoperative images, and intraoperative findings were captured respectively. RESULTS A total of 41 prospective studies were eligible for inclusion, and 35 studies (85.4%) defined IRCT. IRCT was defined on the basis of the following main criteria: preoperative image findings (28/35), intraoperative findings (24/35), and symptoms (16/35). With regard to preoperative images, IRCT was mainly defined on the basis of retraction of the tendon in the coronal plane (22/28), the severity of fatty degeneration (19/28), and ruptured tendon number or width of the defect in the sagittal plane (17/28). CONCLUSION This scoping review highlights the lack of a standardized definition for IRCT in clinical practice, with common predictive criteria including a duration of over 6 months, retraction beyond 5 cm, Goutallier grade 3 fatty infiltration, and the rupture of two or more tendons. However, surgeons should apply more than one criterion when examining preoperative images and confirm reparability during surgery. A more objective manner of evaluating intraoperative reparability is necessary.
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Affiliation(s)
- Fa-Chuan Kuan
- Department of Orthopaedic Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopaedic Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan
- Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Clinica Universidad de los Andes, Santiago, Chile
| | - Tomoyuki Kuroiwa
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Naoya Iida
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan.
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
- Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
- Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan.
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Kany J, Meirlaen S, Werthel JD, van Rooij F, Saffarini M, Grimberg J. Matched Cohort Study Comparing Arthroscopic-Assisted Versus Full-Arthroscopic Latissimus Dorsi Tendon Transfer for Irreparable Massive Rotator Cuff Tears. Orthop J Sports Med 2023; 11:23259671231160248. [PMID: 37179711 PMCID: PMC10170606 DOI: 10.1177/23259671231160248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/01/2023] [Indexed: 05/15/2023] Open
Abstract
Background Latissimus dorsi tendon transfer (LDTT) is increasingly performed with arthroscopic assistance, requiring an open axillary incision, which could increase risks of infection, hematoma, and lymphoedema. Technological advancements now enable LDTT to be fully arthroscopic, but its benefits and safety have not yet been confirmed. Purpose To compare the clinical outcomes and complication rates of arthroscopic-assisted versus full-arthroscopic LDTT for irreparable posterosuperior massive rotator cuff tears in shoulders with no surgical antecedents. Study Design Cohort study; Level of evidence, 3. Methods The study included 90 patients who had undergone LDTT over 4 consecutive years by the same surgeon and did not have prior surgery. During the first 2 study years, all procedures were arthroscopically assisted (n = 52), while during the last 2 years, all procedures were fully arthroscopic (n = 38). Procedure duration and all complications were recorded, as well as clinical scores and range of motion at minimum 24-month follow-up. To enable direct comparison between the techniques, propensity score matching was used to obtain 2 groups with equivalent age, sex, and follow-up. Results From the initial cohort of 52 patients who underwent arthroscopic-assisted LDTT, 8 had complications (15.4%), of which 3 (5.7%) required conversion to reverse shoulder arthroplasty and 2 (3.8%) required drainage or lavage. From the initial cohort of 38 patients who had full-arthroscopic LDTT, 5 had complications (13.2%), of which 2 (5.2%) required conversion to reverse shoulder arthroplasty but no patients (0%) required other procedures. Propensity score matching resulted in 2 groups, each comprising 31 patients, with similar outcomes in terms of clinical scores and range of motion. The procedure time was about 18 minutes shorter for full-arthroscopic LDTT, which had different complications (2 axillary nerve pareses) as compared with arthroscopic-assisted LDTT (1 hematoma and 2 infections). Conclusion Equivalent outcomes at minimum 24-month follow-up were found for arthroscopic-assisted and full-arthroscopic LDTT in terms of complications rates (15.4% and 13.2%, respectively), conversion to reverse shoulder arthroplasty (5.7% and 5.2%), clinical scores, and range of motion.
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Affiliation(s)
- Jean Kany
- Clinique De l’Union, , Ramsay Santé, Saint Jean, France
| | | | | | - Floris van Rooij
- ReSurg SA, Nyon, Switzerland
- Floris van Rooij, MSc, ReSurg SA, Rue Saint Jean 22, Nyon 1260, Switzerland ()
| | | | - Jean Grimberg
- LIRCOS, Clinique Jouvenet, Ramsay Santé, Paris, France
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Hanson JA, Lee S, Horan MP, Rakowski DR, Millett PJ. Superior Capsular Reconstruction Versus Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears: Minimum 5-year Outcomes. Orthop J Sports Med 2023; 11:23259671231166703. [PMID: 37213659 PMCID: PMC10196541 DOI: 10.1177/23259671231166703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 05/23/2023] Open
Abstract
Background Arthroscopic superior capsular reconstruction (SCR) has been introduced as a successful alternative to latissimus dorsi tendon transfer (LDTT) for irreparable posterosuperior rotator cuff tears. Purpose To compare minimum 5-year clinical outcomes of SCR and LDTT for the treatment of irreparable posterosuperior rotator cuff tears in patients with minimal evidence of arthritis and intact or reparable subscapularis tears. Study Design Cohort study; Level of evidence, 3. Methods Patients who underwent SCR or LDTT and had undergone surgery ≥5 years earlier were included. The SCR technique used a dermal allograft customized to the defect. Surgical, demographic, and subjective data were collected prospectively and reviewed retrospectively. Patient-reported outcome (PRO) scores utilized were the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), the short version of the Disabilities of the Arm, Shoulder and Hand score (QuickDASH), 12-Item Short Form Health Survey Physical Component Summary (SF-12 PCS), and patient satisfaction. Further surgical procedures were documented, and treatment that progressed to reverse total shoulder arthroplasty (RTSA) or revision rotator cuff surgery was considered a failure. Kaplan-Meier survivorship analysis was performed. Results Thirty patients (n = 20 men; n = 10 women) with a mean follow-up of 6.3 years (range, 5-10.5 years) were included. A total of 13 patients underwent SCR and 17 patients underwent LDTT. The mean age of the SCR group was 56 years (range, 41.2-63.9 years), and the mean age of the LDTT group was 49 years (range, 34.7-57 years) (P = .006). One patient in the SCR group and 2 patients in the LDTT group progressed to RTSA. Two additional (11.8%) patients in the LDTT group had further surgery-1 had arthroscopic cuff repair and 1 had hardware removal with biopsies. The SCR group demonstrated significantly better ASES (94.1 ± 6.3 vs 72.3 ± 16.4; P = .001), SANE (85.6 ± 8 vs 48.7 ± 19.4; P = .001), QuickDASH (8.8 ± 8.7 vs 24.3 ± 16.5; P = .012), and SF-12 PCS (56.1 ± 2.3 vs 46.5 ± 6; P = .001) PROs at the final follow-up. There was no significant difference between groups in median satisfaction (SCR, 9; LDTT, 8 [P = .379]). At 5 years, survivorship rates were 91.7% and 81.3% for the SCR and LDTT groups, respectively (P = .421). Conclusion At the final follow-up, SCR yielded superior PROs compared with LDTT for the treatment of massive, irreparable posterosuperior rotator cuff tears despite similar patient satisfaction and survivorship between procedures.
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Affiliation(s)
| | - Simon Lee
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- Northwestern Medicine, Chicago,
Illinois, USA
| | | | | | - Peter J. Millett
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado,
USA
- Peter J. Millett, MD, MSc,
Steadman Philippon Research Institute and The Steadman Clinic, 181 West Meadow
Drive, Suite 400, Vail, CO 81657, USA (
) (Twitter: @millettmd)
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Mercurio M, Castricini R, Castioni D, Cofano E, Familiari F, Gasparini G, Galasso O. Better functional outcomes and a lower infection rate can be expected after superior capsular reconstruction in comparison with latissimus dorsi tendon transfer for massive, irreparable posterosuperior rotator cuff tears: a systematic review. J Shoulder Elbow Surg 2023; 32:892-906. [PMID: 36528222 DOI: 10.1016/j.jse.2022.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/25/2022] [Accepted: 11/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Massive, irreparable rotator cuff tears, if left untreated, may result in cuff tear arthropathy, which causes shoulder disability and pain. The primary outcome of this systematic review was to evaluate differences in functional outcomes between the arthroscopic superior capsular reconstruction (SCR) and latissimus dorsi tendon transfer (LDTT) for the treatment of massive, irreparable posterosuperior rotator cuff tears without arthritis. The secondary outcome was to compare complication and reoperation rates between the 2 surgical procedures. METHODS The PubMed, MEDLINE, Scopus, and Cochrane Central databases were searched using keywords, and 20 studies were included in this review. Data extracted for quantitative analysis included the American Shoulder and Elbow Surgeons score, the Constant-Murley score, the subjective shoulder value, the range of motion, the visual analog scale for pain, numbers and types of complications, and reoperation rate. The preoperative fatty degeneration of the muscles and the preoperative and follow-up acromiohumeral distance and glenohumeral osteoarthritis according to the Hamada grading system were also reported. RESULTS A total of 1112 patients were identified, among whom 407 and 399 underwent SCR and LDTT, respectively. The SCR group showed a higher mean age at the time of operation (64.5 ± 7.8 vs. 62.1 ± 8.9 years; P < .001). The SCR group showed a lower rate of previous surgical procedures on the shoulder (35 out of 407 vs. 111 out of 399; P < .001) and a shorter mean follow-up (30.4 ± 7.5 vs. 36.3 ± 10.3 months; P < .001). Patients who underwent SCR reported significantly better functionality and residual pain as measured by the Constant-Murley score (75.5 ± 11.2 vs. 65.6 ± 22.8, P < .001), the American Shoulder and Elbow Surgeons score (84.3 ± 13 vs. 67.7 ± 23, P < .001), the subjective shoulder value (79.4 ± 13 vs. 64.4 ± 23, P < .001), and the visual analog scale (1.4 ± 2 vs. 2.8 ± 3, P < .001) than patients who underwent LDTT. A greater acromiohumeral distance (5.8 ± 2.5 vs. 7.6 ± 2.7, P < .001) was found in the SCR group. The SCR group showed a significantly lower infection rate (0.2% vs. 2.8%., P = .003) and a higher graft failure rate (12.3% vs. 6.8%, P = .012). No differences in terms of reoperation for graft failure (1% vs. 2.3% for SCR and LDTT, respectively; P = .172) or for conversion to reverse total shoulder arthroplasty (1.7% vs. 2% for SCR and LDTT, respectively; P = .800) were found. CONCLUSION Patients undergoing SCR report better functional outcomes and greater acromiohumeral distance than those undergoing LDTT. The LDTT group shows a significantly higher infection rate, while the SCR group shows a significantly higher graft failure rate, but there are no differences in terms of reoperation between the 2 surgical procedures.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, "Villa Verde" Hospital, Fermo, Italy; Department of Orthopaedic and Trauma Surgery, "Villa Maria Cecilia" Hospital, Cotignola, Italy
| | - Davide Castioni
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy; Department of Orthopedic and Trauma Surgery, Girolamo Fracastoro Hospital, Verona, Italy
| | - Erminia Cofano
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy.
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
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Checchia CS, da Silva LA, do Val Sella G, Checchia SL, de Moraes Barros Fucs PM, Miyazaki AN. Allograft-enhanced latissimus dorsi transfer is better than the conventional technique for irreparable posterosuperior rotator cuff tears. A retrospective matched cohort. INTERNATIONAL ORTHOPAEDICS 2023; 47:1527-1534. [PMID: 36951977 DOI: 10.1007/s00264-023-05775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Latissimus dorsi tendon (LDT) transfer (LDTT) to the greater tuberosity to treat irreparable posterosuperior rotator cuff tears (RCTs) in young active patients has been shown to have up to 36% of clinical failures, most of them happening because of either deltoid origin disruption or post-operative transfer rupture from the greater tuberosity. In an attempt to simultaneously prevent both complications, a modified technique includes the following adaptations to the original technique: reinforcement and augmentation of the LDT with a tendinous allograft, enabling the use of a single deltopectoral approach. The aim of this study is to compare mid-term outcomes of the traditional LDTT technique with this modified transfer. METHODS Retrospective cohort study comparing two groups who underwent either the traditional (group 1; n = 19) or the modified technique (group 2; n = 27). Group homogenization was assured by statistical comparison of 24 baseline independent variables. The outcome variables were the gains to active shoulder range of motions (ROM) and UCLA scores (and all its subscores, independently), at a minimum follow-up of two years. A p value < .05 was considered to be statistically significant. RESULTS At a mean follow-up of 25 months, both groups have shown improvements to most variables. However, group two (modified technique) achieved greater improvements to UCLA score (p = .009), active external rotation (p = .006) and internal rotation (p = .008). CONCLUSION At mid-term follow-up, improvements to outcomes of the modified (single approach, allograft-enhanced) latissimus dorsi transfer were greater than those of the original technique.
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Affiliation(s)
- Caio Santos Checchia
- Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil.
- Hospital Sírio-Libanês, São Paulo, Brazil.
| | | | | | - Sergio Luiz Checchia
- Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Alberto Naoki Miyazaki
- Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
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12
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Early postoperative recovery comparisons of superior capsule reconstruction to tendon transfers. J Shoulder Elbow Surg 2023; 32:276-285. [PMID: 36115613 DOI: 10.1016/j.jse.2022.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/11/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The management of massive posterosuperior rotator cuff tears is controversial, with no gold standard. Two recently developed techniques that have shown promising initial results include arthroscopic superior capsular reconstruction (SCR) and tendon transfers (latissimus or lower trapezius). However, there remains a scarcity of studies examining each procedure's early postoperative clinical outcomes individually or in comparison to each other. The purpose of this study is to compare the early postoperative recovery outcomes of tendon transfers (TTs) to SCR. METHODS Using the surgical outcomes system global database (Arthrex Inc.), we assessed the postoperative recovery outcomes for all patients who had outcomes recorded at least 6 months after SCR or TT. The time points analyzed included preoperative and postoperative (2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years). The outcomes analyzed included pain visual analog scale (VAS) score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, VR-12 physical, and Single Assessment Numeric Evaluation (SANE). RESULTS Overall, 163 patients underwent SCR and 24 arthroscopically assisted TT. The mean age for SCR and TT was 60 and 56 years, respectively. Postoperative recovery curves demonstrate that both procedures produced improved outcomes at each postoperative time point compared to preoperative. The pain and functional outcomes measures, including VAS, ASES, SANE, and VR-12 physical, were comparable for TT and SCRs, with similar recovery curves between the 2 techniques. Ultimately at 2 years postoperatively, there were no significant differences between the 2 techniques. CONCLUSIONS Analysis of the early outcomes associated with arthroscopic treatment of massive posterosuperior rotator cuff tears demonstrated that the arthroscopically assisted tendon transfers and arthroscopic superior capsular reconstruction had similar pain and functional outcomes throughout the 2-year postoperative recovery period. Overall, the process of recovery appears equivalent between the 2 techniques. Future studies are needed to assess the outcomes of each technique and specific indications in an attempt to delineate an algorithm for the treatment of irreparable rotator cuff tears.
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13
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Campbell RE, Lee D, Day LM, Dixit A, Freedman KB, Tjoumakaris FP. Management of Massive Rotator Cuff Tears Without Arthropathy. Orthopedics 2023; 46:e1-e12. [PMID: 35876782 DOI: 10.3928/01477447-20220719-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Arthroplasty is not an optimal treatment for massive rotator cuff tears in patients who are active and without glenohumeral arthritis. Several surgical techniques have been developed for these patients, including arthroscopic rotator cuff repair with single-/double-row repair (with or without interval slides, margin convergence, graft augmentation), graft bridging, superior capsular reconstruction, tuberoplasty, and tendon transfers. Complete, tension-free, anatomic repair is ideal; however, tendon atrophy and retraction associated with massive tears often complicate repairs. All surgical treatments significantly increase patient-reported functional outcomes 1 year after intervention, with many treatments demonstrating improved mid-term and long-term outcomes. [Orthopedics. 2023;46(1):e1-e12.].
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14
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Wang Y, Ding W, Xu J, Ruan D, Heng BC, Ding Q, Shen L, Ding S, Shen W. Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears Results in Significant Improvements in Patient Reported Outcomes and Range of Motion: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1523-e1537. [PMID: 36033196 PMCID: PMC9402467 DOI: 10.1016/j.asmr.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The purposes of this study were to evaluate the clinical outcomes (with the minimum mean follow-up period of 2 years) of arthroscopic superior capsular reconstruction (ASCR) using different grafts for massive irreparable rotator cuff tears (MIRCTs) and to explore whether margin convergence in ASCR affects range of motion (ROM) outcomes. Methods This systematic review was registered in PROSPERO and was then conducted following PRISMA guidelines by searching the databases: MEDLINE, EMBASE, Web of Science, and Cochrane Library database before April 2021. These literature searches investigating the clinical outcomes of ASCR were included. The methodological quality of included studies was assessed using the MINORS criteria. The data, including margin convergence, patient-reported outcome scores, range of motion, and complications, were extracted and analyzed. The minimal clinically important differences (MCID) criteria was used to define clinical significance. Results 15 studies met the inclusion criteria. All studies reported statistically significant improvements in visual analog scale scores (range: 2.07 to 7.1) and American Shoulder and Elbow Surgeons scores (range: 18.1 to 58). Significant improvements of Constant scores were noted in 4 of 5 reporting studies (mean improvement ranged from 14.64 to 50.79). Active forward flexion/elevation (11 studies), active abduction (4 studies), and active external rotation (8 studies) displayed improvements in all reporting studies, with mean changes ranging from 12 to 73.68, 19 to 89.21, and 1 to 24.74, respectively. The mean change of postoperative acromiohumeral distance ranged from −0.86 mm to 3.2 mm in 9 studies. The postoperative complication rate of ASCR ranged from 4.5% to 47.6%. The anterior margin convergence in SCR was associated with a relatively poor improvement in active external rotation. Conclusions ASCR contributes to significant improvements in patient-reported clinical outcomes and ROM at follow-up after a mean of more than two years, emerging as a viable option for patients with MIRCTs. The anterior margin convergence should be prudently chosen, especially in ASCR using fascia lata autograft, on account of the probable restriction on postoperative active external rotation. Level of Evidence Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Yongjian Wang
- Department of Orthopedics, First People’s Hospital of Wenling, Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, hejiang, PR China
| | - Wei Ding
- Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, PR China
| | - Jungang Xu
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dengfeng Ruan
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Boon Chin Heng
- Peking University School of Stomatology, Beijing, PR China
| | - Qianhai Ding
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingfang Shen
- Air Force Health Care Center for Special Services, Hangzhou, PR China
| | - Shaohua Ding
- Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, PR China
- Shaohua Ding, M.D., Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, 57 Xingning Road, Ningbo, 315000, PR China.
| | - Weiliang Shen
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Orthopaedics Research Institute of Zhejiang University, Zhejiang, PR China; China Orthopaedic Regenerative Medicine (CORMed), Hangzhou, PR China; Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Zhejiang, PR China; Department of Sports Medicine, School of Medicine, Zhejiang University, Zhejiang, PR China; Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang University Huzhou Hospital, Huzhou, Zhejiang, PR China
- Address correspondence to Weiliang Shen, M.D., Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou 310009, China.
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Miyazaki AN, Checchia CS, Fonseca Filho JM, Rosa JRP, Val Sella GD, Silva LAD. Resultados da transferência do grande dorsal alongado com enxerto tendíneo homólogo por via delto-peitoral para lesões póstero-superiores irreparáveis do manguito rotador. Rev Bras Ortop 2022; 57:590-598. [PMID: 35966441 PMCID: PMC9365491 DOI: 10.1055/s-0041-1724073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/02/2020] [Indexed: 11/15/2022] Open
Abstract
Objective
The primary aim of the present study is to evaluate the functional results of a modification to the latissimus dorsi (LD) transfer around the shoulder for irreparable posterosuperior rotator cuff tears. The secondary aim is to evaluate variables that might influence the outcomes.
Surgical Technique
Through a single deltopectoral approach, the LD tendon is detached, reinforced, and elongated with a tendinous allograft, transferred around the humerus, and fixed superolaterally to the greater tuberosity and anteriorly to the subscapularis.
Methods
Retrospective functional evaluation of 16 cases. The average follow-up was 21 months (12–47). The postoperative results (at last follow-up) were compared with the preoperative ones, as well as to other pre, intra, and postoperative variables.
Results
All (but one) patients were satisfied. Average University of California, Los Angeles (UCLA) score increased from 11.6 (8–16) to 27.3 (17–30) (
p
< 0.001). Improvements of shoulder pain, function, and strength achieved statistical significance (
p
< 0.001). Nonetheless, normal strength was never restored. Average active range of motion improved as follows: forward elevation, from 106° (60–140°) to 145° (130–160°) (
p
< 0.001); external rotation from 30° (0° to 60°) to 54° (40–70°) (
p
< 0.001); and internal rotation from L1 (gluteus to T7) to T10 (T12–T3) (
p
< 0.05). No complication has occurred. Preoperative pseudoparesis was reverted in all the six cases in which it was present. None of the variables analyzed influenced the outcomes, including pseudoparesis.
Conclusions
At early follow-up, this technique is safe and effective at recovering from pseudoparesis and at improving shoulder pain, function, and strength.
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Affiliation(s)
- Alberto Naoki Miyazaki
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Caio Santos Checchia
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - João Manoel Fonseca Filho
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
- Departamento de Cirurgia Ortopédica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - João Roberto Polydoro Rosa
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
- Departamento de Cirurgia Ortopédica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - Guilherme do Val Sella
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Luciana Andrade da Silva
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
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Lopez-Fernandez V, Mariaux S, Lafosse L, Lafosse T. Technical Guide and Tips to Posterior Arthroscopic Latissimus Dorsi Transfer for Irreparable Posterosuperior Rotator Cuff Tears. Arthrosc Tech 2022; 11:e755-e762. [PMID: 35646569 PMCID: PMC9134106 DOI: 10.1016/j.eats.2021.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/17/2021] [Indexed: 02/03/2023] Open
Abstract
Latissimus dorsi (LD) transfer is a reliable treatment option for irreparable posterosuperior (PS) rotator cuff tears in young and active patients that need to recover the range of motion for their daily living activities. The technique starts with an arthroscopic assessment of the tear. The next step is the mini-open stage for muscle release from the subcutaneous layer of the skin, the teres major (TM), the triceps, and the lateral border and inferior angle of the scapula. Later, the scope is used to prepare the footprint (arthroscopy) and for the release and the harvest of the tendon (endoscopy), taking care not to detach the TM and not to damage the radial nerve. A grasper is used to push the LD to its correct path medial to the triceps. After that the same instrument is placed from the anterolateral and the anterior arthroscopic portals toward the mini-open incision to catch the sutures previously loaded on the LD tendon with Krackow stitches. The LD is transferred to the greater tuberosity and is attached with one medial and one lateral knotless anchors. A third point of fixation enables a partial RC repair and ensures a surface of bone to tendon healing.
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Affiliation(s)
- Vanesa Lopez-Fernandez
- Hand, UpperLimb, Brachial Plexus, and Microsurgery Unit, Clinique Générale d'Annecy, Annecy, France
| | - Sandrine Mariaux
- Service of Orthopedics and Traumatology, Collombey-Muraz, Switzerland
| | - Laurent Lafosse
- Hand, UpperLimb, Brachial Plexus, and Microsurgery Unit, Clinique Générale d'Annecy, Annecy, France
| | - Thibault Lafosse
- Hand, UpperLimb, Brachial Plexus, and Microsurgery Unit, Clinique Générale d'Annecy, Annecy, France
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Waltenspül M, Jochum B, Filli L, Ernstbrunner L, Wieser K, Meyer D, Gerber C. Mid-term results of arthroscopically assisted latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears. J Shoulder Elbow Surg 2021; 30:e676-e688. [PMID: 33878485 DOI: 10.1016/j.jse.2021.03.149] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/21/2021] [Accepted: 03/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND With progress in arthroscopic surgery, latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears (RCTs) has become a reliable all-arthroscopic or arthroscopically assisted procedure. The mid-term results of arthroscopically assisted latissimus dorsi transfer (aLDT) are scarce in the literature. The purpose of this study was to report our clinical and radiographic mid-term results of aLDT for irreparable posterosuperior RCTs. METHODS Thirty-one consecutive patients with a mean age of 55.5 years (range, 38-73 years) at the time of aLDT were evaluated after a mean of 3.5 years (range, 2-5 years). All patients had irreparable, full-thickness tears of at least the complete supraspinatus, with or without infraspinatus tendons, and 12 patients (39%) had undergone previous rotator cuff repair (RCR). A concomitant upper-third subscapularis repair was needed at the time of aLDT in 7 patients (23%). Mid-term results were assessed clinically and radiographically (including magnetic resonance imaging). RESULTS At final follow-up, 4 patients with failure (13%) had undergone revision to reverse total shoulder arthroplasty (RTSA) essentially for untreatable pain. Patients with revision to RTSA had significantly higher preoperative pain levels (Constant pain score, 6 points vs. 11 points; P = .032) and lower Constant activity scores (2 points vs. 5 points, P = .017) than the remaining 27 patients. Patients with failed previous RCRs had significantly inferior results compared with patients without previous repair (mean Subjective Shoulder Value, 67% vs. 88%; P = .035). For the 27 patients without revision, the mean relative Constant score improved from 63% to 76% (P = .032), the Constant pain score, from 10.5 to 12.7 points (P = .012), and the Subjective Shoulder Value, from 43% to 77% (P < .001). Significant progression of glenohumeral arthropathy by 2 or more grades according to the Hamada classification was observed in 13 of the 27 patients (48%), but there was no significant difference in clinical outcomes between the patients with arthropathy (n = 13) and those without it (n = 14, P = .923). CONCLUSIONS The mid-term results of aLDT for irreparable posterosuperior RCTs were associated with significant improvements in objective and subjective outcome measures. The failure rate leading to conversion to RTSA was relatively high in this cohort. The failures were associated with unusually intense pain in low-demand individuals and/or revision of failed RCR. Long-term results of aLDT are needed to evaluate the effect of this procedure on the progression of osteoarthritis.
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Affiliation(s)
- Manuel Waltenspül
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| | - Benedikt Jochum
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lukas Filli
- Department of Radiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Dominik Meyer
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Kucirek NK, Hung NJ, Wong SE. Treatment Options for Massive Irreparable Rotator Cuff Tears. Curr Rev Musculoskelet Med 2021; 14:304-315. [PMID: 34581991 PMCID: PMC8497660 DOI: 10.1007/s12178-021-09714-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Massive irreparable rotator cuff tears present a significant challenge to the orthopedic surgeon. No single treatment, particularly among joint-preserving options, has been shown to be superior. The purpose of this review is to discuss recent advances in the treatment of massive irreparable rotator cuff tears, including partial repair with and without graft augmentation, interposition grafts, superior capsule reconstruction, subacromial balloon spacers, tendon transfer, and reverse total shoulder arthroplasty. We will also offer guidance on surgical indications based on our clinical experience. RECENT FINDINGS Partial repair may offer reasonable clinical improvement for patients with lower preoperative function despite high re-tear rates. Additionally, several types of interposition grafts have shown promising short-term results and may outperform repair alone. Subacromial balloon spacers may lead to clinical improvement, especially in patients without glenohumeral osteoarthritis or pseudoparalysis, and recently received FDA approval for use in the USA. Superior capsule reconstruction is a technically demanding procedure that appears to produce excellent short-term results particularly when performed at high volume, but long-term studies in heterogeneous study groups are needed. Tendon transfers improve function by restoring force coupling in the shoulder, offering a promising option for younger patients. Reverse total shoulder arthroplasty (RTSA) is a reliable option for treatment of irreparable cuff tears in elderly patients with lower functional demands. Irreparable cuff tears remain a difficult condition to treat. Recommended treatment for younger patients without glenohumeral osteoarthritis is particularly controversial. For older patients with low-demand lifestyles and glenohumeral osteoarthritis, RTSA is an effective treatment option. For all discussed procedures, patient selection appears to play a critical role in clinical outcomes.
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Affiliation(s)
- Natalie K. Kucirek
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Nicole J. Hung
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Stephanie E. Wong
- Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens Street, San Francisco, CA 94158 USA
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Lee KW, Choi HG, Yang DS, Yu YT, Kim WS, Choy WS. Achilles Tendon Allograft for Superior Capsule Reconstruction in Irreparable Massive Rotator Cuff Tears. Clin Orthop Surg 2021; 13:395-405. [PMID: 34484633 PMCID: PMC8380524 DOI: 10.4055/cios20284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
Backgroud Treatment remains a challenge in massive and irreparable rotator cuff tears (RCTs), and superior capsular reconstruction (SCR) has become an increasingly popular choice. The objective of this study was to evaluate clinical and radiological outcomes after SCR using an Achilles tendon allograft in irreparable massive RCTs. Methods From December 2015 to March 2018, 11 patients (mean age, 66.3 ± 5.8 years) with irreparable massive RCTs who underwent SCR using an Achilles tendon allograft were enrolled in this study. The range of motion (ROM), visual analog scale (VAS), clinical scores, muscle strength, and acromiohumeral distance (AHD) were measured preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively. Magnetic resonance imaging (MRI) was performed preoperatively and at 6 months postoperatively to assess the global fatty degeneration index and graft failure. Ultrasonography was also conducted preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively to assess graft continuity. Results The mean follow-up period was 27.6 months (range, 24–32 months). The shoulder ROM at final follow-up increased significantly in forward flexion (p = 0.023), external rotation (p = 0.018), internal rotation (p = 0.016), and abduction (p = 0.011). All patients showed improvement in VAS score (p = 0.005) and clinical scores (p < 0.001) compared with the preoperative state. Pseudoparalysis improved in all patients. The AHD was 3.88 mm (± 1.21 mm) preoperatively, 7.75 mm (± 1.52 mm, p = 0.014) at 6 months postoperatively, and 6.37 mm (± 1.72 mm, p = 0.031) at final follow-up. Graft removal and synovectomy were performed in 1 patient who developed postoperative infections. Radiological failure on follow-up MRI occurred in 2 patients at 6 and 12 months postoperatively, respectively. Conclusions SCR using an Achilles tendon allograft in irreparable massive RCTs achieved functional and clinical improvement. The use of Achilles tendon allograft also has the advantages of short operation time without donor site morbidity, sufficient thickness, and robustness; therefore, this allograft can be a useful graft for SCR.
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Affiliation(s)
- Kwang Won Lee
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Han Gyeol Choi
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dae Suk Yang
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Young Tak Yu
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Woo Suk Kim
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
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Alarcon JF, Uribe-Echevarria B, Clares C, Apablaza D, Vargas JC, Benavente S, Rivera V. Superior Capsular Reconstruction With Autologous Fascia Lata Using a Single Lateral-Row Technique Is an Effective Option in Massive Irreparable Rotator Cuff Tears: Minimum 2-Year Follow-Up. Arthroscopy 2021; 37:2783-2796. [PMID: 33957215 DOI: 10.1016/j.arthro.2021.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate clinical and radiologic outcomes of arthroscopic superior capsular reconstruction (ASCR) with fascia lata autograft in patients with irreparable rotator cuff tears (IRCTs) performed using a single lateral-row fixation technique. METHODS We studied a retrospective case series of patients with large or massive IRCTs for ASCR with fascia lata autograft. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Constant score. Healing of the graft was assessed by magntic resonance imaging or ultrasound. Acromiohumeral distance was evaluated by radiographs. RESULTS Thirty-one patients with an average age of 61 years and an average follow-up of 35 months (24-51 months) underwent ASCR with fascia lata autograft. There was a significant improvement in VAS (7.7-0.7), Constant score (36.0-78.7), forward elevation (115°-171°), external rotation (33°-50°), strength (0.3 kg-2.3 kg), and acromiohumeral distance (6.1 mm-8.6 mm) (P < 0.001). Graft failure was present in 13.8% of patients, as shown by magnetic resonance imaging (26 patients) or ultrasound (3 patients). Patients with failed ASCR showed worse Constant scores (68.5.8 vs 80.2, P = 0.007), worse VAS (2.5 vs 0.4, P = 0.00002), worse external rotation (20° vs 54°, P = 0.004), lower acromiohumeral distance (5mm vs 9mm, P = 0.007), and a high association with the presence of os acromiale (χ2P = 0.003). No revision or subsequent surgical procedures were required. CONCLUSIONS ASCR, with autologous fascia lata and single lateral row configuration, is an effective option in irreparable rotator cuff tears and results in clinical and radiologic improvement. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | - Bastian Uribe-Echevarria
- Centro de Especialides Traumatologicas, Puerto Varas, Chile; Centro de Especialides Traumatologicas, Puerto Varas, Chile.
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21
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Kim D, Um J, Lee J, Kim J. Improved Clinical and Radiologic Outcomes Seen after Superior Capsule Reconstruction using Long Head Biceps Tendon Autograft. Arthroscopy 2021; 37:2756-2767. [PMID: 33892071 DOI: 10.1016/j.arthro.2021.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to investigate the clinical and radiologic outcomes after superior capsule reconstruction (SCR) with biceps tendon (BT) for irreparable rotator cuff tears. METHODS The retrospective study period was May 2015 through February 2018. The average follow-up was 32 months (24-48 months) after surgery. Study inclusion criteria included an arthroscopic SCR performed using only our technique and minimum 2-year clinical follow-up by office visit and survey. Exclusion criteria included irreparable subscapularis tear and those patients lost to follow-up. This method enabled SCR by using the extraarticular portion and the intraarticular portion and making it 2 to 3 bundles by moving back and forth in the intraarticular area. Physical examination and functional scoring procedures were performed before surgery and at 3, 6, 12, and 24 months after surgery. Radiography and magnetic resonance imaging (MRI) were performed before surgery, after surgery (only radiography), and at 6 and 24 months after surgery. RESULTS Fifty-three shoulders involving 45 consecutive patients underwent BT technique for irreparable massive rotator cuff tears. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and constant score (CS) showed statistically significant improvement (VAS, 4.1-1.0; ASES, 60.9-82.7; and CS, 64.9-80.0; P < .0001). The shoulder active range of motion improved significantly by 23 for forward elevation (125.3-148.4; P < .0001) and by 12 for external rotation (38.0-50.9, P < .0001). The acromiohumeral distance (AHD) was significantly increased by 2.7 mm (4.4 ± 1.4 mm -> 7.1 ± 1.3 mm). No graft tear was detected in 39 patients (86.7%) during follow-up (24-48 months). CONCLUSIONS SCR via our technique improved clinical and radiologic outcomes. Thirty-five (77.7%) patients achieved 17-point improvement (the minimally clinically important difference) in the last follow-up of ASES score. Clinical scores and AHD had significantly increased, and good healed rate (86.7%) was observed in MRI. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Doosup Kim
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea; Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Wonju, Republic of Korea
| | - Jaewoong Um
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Junhyeok Lee
- Department of biostatistics, College of Medicine, Yonsei University, Republic of Korea
| | - Jaehyeon Kim
- Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Wonju, Republic of Korea.
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22
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Broida SE, Sweeney AP, Gottschalk MB, Woodmass JM, Wagner ER. Clinical outcomes of latissimus dorsi tendon transfer and superior capsular reconstruction for irreparable rotator cuff tears: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1023-1043. [PMID: 34370112 DOI: 10.1007/s00590-021-03046-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Functionally irreparable rotator cuff tears (FIRCTs) present an ongoing challenge to the orthopedic surgeon. The aim of this systematic review was to critically compare the outcomes of three latissimus dorsi tendon transfer (LDT) techniques and two superior capsular reconstruction (SCR) techniques in treatment of FIRCTs. METHODS A systematic review of studies evaluating the outcome of FIRCT treatment was performed via a search of four databases in April 2020. Each included study was reviewed in duplicate by two reviewers for evaluation of methodological quality. The treatments analyzed were arthroscopic LDT (aLDT), open LDT Gerber technique (oLDTG), open LDT L'Episcopo technique (oLDTL), SCR with allograft (SCR-Allo), and SCR with autograft (SCR-TFL). Demographics, range of motion, patient-reported outcome measures, radiographic acromiohumeral distance (AHD), treatment failures, and revisions were recorded. RESULTS Forty-six studies (1287 shoulders) met criteria for inclusion. Twenty-three studies involved open latissimus transfer, with 445 shoulders undergoing oLDTG with mean follow-up of 63.2 months and 60 patients undergoing oLDTL with mean follow-up of 51.8 months. Ten studies (n = 369, F/U 29.2mo) reported on aLDT. Seven studies (n = 253, F/U 16.9mo) concerned SCR-Allo, and six studies (n = 160, F/U 32.mo) reported on SCR-TFL. Range of motion and subjective outcome scores improved in all techniques with no differences across treatments. Both SCR methods provided greater improvement in AHD than open LDT methods (p < 0.01). The re-tear rates were lower in both oLDT groups compared to the SCR groups (p = 0.03). Clinical failure rates were higher in the SCR-Allo and oLDTG groups, while overall treatment failures were lowest in oLDTL compared to all four other groups. CONCLUSION SCR techniques were associated with improved short-term radiographic acromiohumeral distance, while the open LDT techniques had lower tendon re-tear and treatment failure rates. All techniques resulted in improved clinical outcomes and pain relief compared to preoperative levels with no differences across techniques. LEVEL OF EVIDENCE IV Systematic review of case series and cohort studies.
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Affiliation(s)
- Samuel E Broida
- Department of Orthopaedic Surgery, Emory University, 59 S Executive Park NW, Atlanta, GA, 30329, USA
| | - Aidan P Sweeney
- Department of Orthopaedic Surgery, Emory University, 59 S Executive Park NW, Atlanta, GA, 30329, USA
| | - Michael B Gottschalk
- Department of Orthopaedic Surgery, Emory University, 59 S Executive Park NW, Atlanta, GA, 30329, USA
| | - Jarret M Woodmass
- Department of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Canada
| | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University, 59 S Executive Park NW, Atlanta, GA, 30329, USA.
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Checchia CS, Silva LAD, Sella GDV, Fregoneze M, Miyazaki AN. Current Options in Tendon Transfers for Irreparable Posterosuperior Rotator Cuff Tears. Rev Bras Ortop 2021; 56:281-290. [PMID: 34239191 PMCID: PMC8249074 DOI: 10.1055/s-0040-1709988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/10/2020] [Indexed: 10/28/2022] Open
Abstract
Massive irreparable posterosuperior rotator-cuff tears are debilitating lesions that usually require surgical treatment. Even though there is no consensus regarding the best surgical technique, tendinous transfers around the shoulder are the most commonly performed procedures. The latissimus dorsi tendon remains the most commonly used, but different modifications to the original technique have been shown to minimize complications and to improve functional results and satisfaction. Other techniques, such as the transfer of the lower trapezius tendon, are promising and should be considered, especially for patients with isolated loss of external rotation. The present paper is a literary review regarding tendon transfers for irreparable posterosuperior rotator-cuff tears.
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Affiliation(s)
- Caio Santos Checchia
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Luciana Andrade da Silva
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Guilherme do Val Sella
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Marcelo Fregoneze
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Alberto Naoki Miyazaki
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
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Cartaya M, Canales P, Werthel JD, Hovsepian JM, Valenti P. Feasibility of lower trapezius and rhomboid minor transfer for irreparable subscapularis tears: an anatomic cadaveric study. JSES Int 2021; 5:447-453. [PMID: 34136852 PMCID: PMC8178634 DOI: 10.1016/j.jseint.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Previously reported outcomes after tendon transfers to reconstruct the subscapularis are unpredictable and often unsatisfactory, especially in the presence of anterior humeral head subluxation. We studied the anatomic feasibility of the lower trapezius and the rhomboid minor transfer to reconstruct irreparable tendon tears of the subscapularis. The aim of this study was to determine the feasibility of lower trapezius and rhomboid minor transfer to reconstruct irreparable subscapularis tendon tears. Materials and methods We measured the tendons dimensions, muscles excursions, distances to pedicles, and dissection needed to complete a successful lower trapezius and/or rhomboid minor transfer to the subscapularis footprint in 10 cadaveric shoulders. The transferred muscles were detached distally, augmented with a semitendinosus and gracilis autograft, and passed anteriorly between the scapula and the subscapularis remnant through a small serratus window to reach the lesser tuberosity. The risk of pedicle compression was subjectively assessed in all cases. Results The trapezius and rhomboid tendons were asymmetric with an average length of 37.6 mm and 21.7 mm, an average width of 63 mm and 33.4 mm, respectively. The mean distances from each distal insertion to the lesser tuberosity were 109 mm for the trapezius and 144 mm for the rhomboid. Mean distances from tendon to pedicle were 57.9 mm and 33.1 mm, respectively. The mean size of the necessary serratus window was 49.4 mm, which was measured at maximal excursion achieved at maximal external rotation 90° representing two digitations. All of the tendon transfers were feasible, and the risk of pedicle compression was 20% for the trapezius and 10% for the rhomboid. Superior migration of the transfer was observed during passive external rotation if the insertion point was too high. Conclusions Transfer of the lower trapezius and rhomboid minor to the lesser tuberosity to reconstruct an irreparable subscapularis tear is feasible without extensive dissection and with a low risk of nerve compression. We recommend not to transfer the rhomboid minor routinely, owing to the risk of tendon luxation after external rotation of the shoulder.
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Affiliation(s)
| | | | | | - Jean Michel Hovsepian
- Department of Orthopaedic Sports Medicine, Chirurgisches Klinikum München Süd, Munich, Germany
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25
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Reinares F, Calvo A, Bernal N, Lizama P, Valenti P, Toro F. Arthroscopic-assisted latissimus dorsi transfer for irreparable posterosuperior cuff tears: Clinical outcome of 15 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:667-674. [PMID: 34081197 DOI: 10.1007/s00590-021-03025-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We analyzed the clinical and functional results of patients with irreparable posterosuperior rotator cuff tears treated with arthroscopic-assisted latissimus dorsi transfer and the clinical relevance of the addition of partial repair of the remaining cuff to the transfer. METHODS This was a prospective cohort study that included patients diagnosed with irreparable massive rotator cuff tears treated by arthroscopic-assisted latissimus dorsi transfer between 2015 and 2018. Demographic characteristics, clinical and functional outcomes (Constant-Murley (CS) score and subjective shoulder value (SSV)), and the incidence of complications were evaluated. Clinical outcomes were compared between patients treated with transfer alone and transfer with partial cuff repair. RESULTS Fifteen patients were included, with an average follow-up of 37 ± 16 months. The median duration of symptoms before surgery was 66 weeks (24-208). A significant increase in forward elevation of 52° (p < 0.003) and abduction of 48° (p < 0.001) was obtained. The CS score increased by 48 points (p < 0.001), and the SSV changed from 29% preoperatively to 70% postoperatively (p < 0.001), with a significant decrease in the visual analog pain score from 7 to 1 (p < 0.001). In 10 patients, partial repair of the rotator cuff was also performed. No statistically significant differences were found in these patients compared with patients treated with transfer alone. Two patients presented complications, including transient sensitive neuropraxia of the axillary nerve and seroma, which were managed conservatively and did not affect the outcomes. CONCLUSION Arthroscopic-assisted latissimus dorsi transfer is a safe technique that significantly improves clinical and functional outcomes in selected patients. Longer follow-up and comparison with other treatment options are needed to confirm these excellent results in this group of difficult-to-treat patients. LEVEL OF EVIDENCE IV Nil.
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Affiliation(s)
- Felipe Reinares
- Facultad de Medicina Clínica Alemana Santiago - Universidad del Desarrollo, Santiago, Chile. .,Hospital Clínico Mutual de Seguridad, Santiago, Chile.
| | - Andres Calvo
- Hospital Clínico Mutual de Seguridad, Santiago, Chile
| | - Nazira Bernal
- Facultad de Medicina Clínica Alemana Santiago - Universidad del Desarrollo, Santiago, Chile
| | - Pedro Lizama
- Hospital Clínico Mutual de Seguridad, Santiago, Chile
| | | | - Felipe Toro
- Facultad de Medicina Clínica Alemana Santiago - Universidad del Desarrollo, Santiago, Chile
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Adam JR, Nanjayan SK, Johnson M, Rangan A. Tendon transfers for irreparable rotator cuff tears. J Clin Orthop Trauma 2021; 17:254-260. [PMID: 33936946 PMCID: PMC8079430 DOI: 10.1016/j.jcot.2021.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/23/2021] [Accepted: 03/27/2021] [Indexed: 12/20/2022] Open
Abstract
Symptomatic irreparable rotator cuff tears pose a challenge for shoulder surgeons. Whilst reverse polarity shoulder arthroplasty is an effective option for older symptomatic patients who have exhausted conservative management, the optimal treatment for younger patients remains controversial. In this article we outline the main tendon transfer options, including anatomical considerations, indications, contraindications, surgical technique, complications and a review of the evidence. Tendon transfers provide an alternative joint-preserving surgical option, but the evidence so far is limited, with a clear need for well-designed comparative studies to confirm their effectiveness.
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Affiliation(s)
- John R. Adam
- The James Cook University Hospital, Middlesbrough, UK
| | | | | | - Amar Rangan
- The James Cook University Hospital, Middlesbrough, UK
- The Mary Kinross Trust & RCS Chair, Department of Health Sciences & Hull York Medical School, University of York, UK
- Faculty of Medical Sciences & NDORMS, University of Oxford, UK
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27
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Kadow TR, Meredith SJ, Garcia D, Minorini R, Delaney R, Baratz M, Lin A. Latissimus Dorsi Tendon Transfer and Superior Capsular Reconstruction for Irreparable, Posterosuperior Rotator Cuff Tears. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:44-49. [PMID: 33778114 DOI: 10.22038/abjs.2020.50854.2527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to compare latissimus dorsi tendon transfer (LDTT) and arthroscopic superior capsular reconstruction (SCR) to determine if one is superior to the other regarding improvement in range of motion (ROM) or patient-reported outcomes (PROs). Methods A multicenter, retrospective cohort study was conducted on 43 patients with an irreparable, posterosuperior rotator cuff tear who underwent either LDTT or SCR. Preoperative and postoperative forward flexion and external rotation, as well as PROs including ASES, VAS, and SSV, were assessed. Student t-test and chi-square statistical analyses were performed. Results 16 LDTT, at mean follow-up of 18 months, and 27 SCR, at mean follow-up 15 months, were studied. Mean active forward flexion significantly improved from 85.2° to 137.6° in the SCR cohort (P=0.001). SCR patients demonstrated a significantly greater increase in forward flexion as compared to LDTT patients (52.4° vs 14.1°, P=0.001). Mean active external rotation amongst the LDTT group significantly improved from 41.7° to 61.5° (P=0.032). LDTT demonstrated significantly greater improvement in external rotation as compared to SCR (19.4° vs 0.8°, P=0.011). There were no significant differences in reported ASES, VAS, or SSV scores. Conclusion This study demonstrates successful clinical and patient-reported outcomes with both LDTT and SCR for irreparable, posterosuperior rotator cuff tears, with greater improvement in forward flexion with SCR and greater improvement in external rotation with LDTT.
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Affiliation(s)
- Tiffany R Kadow
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sean J Meredith
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | - Mark Baratz
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Albert Lin
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Kany J, Sekakaran P, Amavarathi RS, Patil P, Grimberg J, Valenti P, Werthel JD. Posterior latissimus dorsi transfer for massive irreparable posterosuperior rotator cuff tears: does it work in the elderly population? A comparative study between 2 age groups (≤55 vs. ≥75 years old). J Shoulder Elbow Surg 2021; 30:641-651. [PMID: 32650083 DOI: 10.1016/j.jse.2020.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND/OR BACKGROUND Management of irreparable posterosuperior rotator cuff tears (RCTs) presents a significant challenge to shoulder surgeons. Previous studies on latissimus dorsi transfer (LDT) have demonstrated good to excellent outcomes in younger patients, but this indication is debatable in the elderly. The main objective of this study was to compare the results of LDT in a group of patients aged ≤55 years vs. one of patients aged ≥75 years. We hypothesized that LDT could give equally good results in the elderly as in the younger population. METHODS Between 2014 and 2017, a total of 153 patients who underwent LDT either for irreparable posterosuperior RCT or for failed prior repair were enrolled. All LDTs were performed by a single surgeon, were arthroscopically assisted, and fixed onto the humeral head with 2 anchors. A retrospective comparative clinical study was conducted. Patients with a minimum of 24 months of follow-up were divided into 2 groups: group A (≤55 years old at surgery) and group B (≥75 years old at surgery). The age-adjusted Constant-Murley score (aCMS), Subjective Score Value (SSV), Simple Shoulder Test (SST), Activities of Daily Living requiring active External Rotation (ADLER) score, visual analog scale for pain (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, patient's satisfaction, and rate of LD tendon rupture at last follow-up were compared. RESULTS A total of 66 patients met inclusion criteria. Four in 66 patients (6%) were lost to follow-up. There were 31 patients in group A and 31 patients in group B. The mean age was 52 and 77 years for the respective groups. Preoperatively, the 2 groups were comparable with respect to other characteristics like the mean number of ruptured tendons, mean preoperative Hamada stage, mean SST, and mean aCMS. The mean follow-up was 33 and 31 months, respectively. At last follow-up, there was no significant difference in the scores evaluated between groups A and B with SSV (61 vs. 66.7 points), ADLER (23 vs. 26.4 points), VAS (2.8 vs. 2.2 points), and ASES (64.4 vs. 72.4 points), respectively, except for the aCMS (75 vs. 96.3; ±001) and the SST (6.2 vs. 8.3; P < .001). Patient's satisfaction was not significantly different in both groups (81% of either satisfied or very satisfied patients in both groups). The rate of LD tendon rupture was higher in group A: 10 (33%) vs. 8 (26%). CONCLUSION Posterior transfer of latissimus dorsi tendon could be an effective surgical option for the treatment of massive irreparable posterosuperior cuff tears in patients ≥75 years of age.
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Affiliation(s)
- Jean Kany
- Clinique de l'Union, Shoulder Department, Ramsay GDS, Saint Jean, France.
| | | | - Rajkumar S Amavarathi
- Division of Arthroscopy and Sports Surgery, Department of Orthopaedics, St John's Medical College and Hospital, Bangalore, India
| | - Prateek Patil
- Orthopedics, DNB Orthopedics, FNB Sports Medicine, Clinique de l'Union, Shoulder Department, Ramsay GDS, Saint Jean, France
| | - Jean Grimberg
- LIRCOS, Clinique Jouvenet, Shoulder Department, Ramsay GDS, Paris, France
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Subacromial Balloon Spacer for Massive, Irreparable Rotator Cuff Tears Is Associated With Improved Shoulder Function and High Patient Satisfaction. Arthroscopy 2021; 37:480-486. [PMID: 33068742 DOI: 10.1016/j.arthro.2020.09.048] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate associations between clinical and demographic parameters and Constant-Murley (CM) scores after subacromial balloon placement for massive, irreparable rotator cuff tears and to evaluate implant survival, shoulder function, and patient satisfaction. METHODS We prospectively analyzed patients with rotator cuff tears deemed irreparable on preoperative magnetic resonance imaging for whom nonoperative therapy was unsuccessful and who underwent balloon placement from 2014 to 2017 with minimum 1-year follow-up. Shoulder function was assessed using the CM score and the 12-Item Short Form Health Survey. RESULTS The study included 51 patients (22 women and 29 men) with a mean age at surgery of 63 years (range, 50-78 years). The mean follow-up period was 36 months (range, 24-56 months). The postoperative acromiohumeral interval and total preoperative CM score predicted the postoperative CM score at final follow-up. The implant survival rates were 92% at 6 and 12 months, 90% at 2 years, and 87% at 3 and 4 years. Five patients underwent reverse total shoulder arthroplasty, and 1 underwent latissimus dorsi tendon transfer. Postoperatively, mean CM scores (± standard deviation) improved for range of motion (from 11 ± 5.4 to 34 ± 6.8) and strength (from 13 ± 5.4 to 28 ± 12) (P < .01 for both). The total CM score improved from 27 ± 7.4 preoperatively to 77 ± 15 postoperatively (P < .01). The physical and mental component summary scores on the 12-Item Short Form Health Survey improved from 27 ± 5.0 to 51 ± 6.5 (P = .02) and from 44 ± 15 to 56 ± 8.0, respectively (P < .01). Thirty-eight patients reported excellent satisfaction, 8 were satisfied, and 5 were dissatisfied. Of the patients, 50 (98%) exceeded the minimal clinically important difference (≥10.4) and patient acceptable symptom state (≥44). CONCLUSIONS At mean 3-year follow-up, subacromial balloon spacer placement for massive, irreparable rotator cuff tears was associated with a significant improvement in shoulder function, limited need for revision surgery, and high patient satisfaction. A greater postoperative acromiohumeral interval and lower preoperative CM score predicted a lower postoperative CM score at final follow-up. LEVEL OF EVIDENCE Level IV, retrospective cohort study and treatment study.
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Moroder P, Akgün D, Lacheta L, Thiele K, Minkus M, Maziak N, Khakzad T, Festbaum C, Rüttershoff K, Ellermann S, Weiss T, Jöns T, Danzinger V. Middle trapezius transfer for treatment of irreparable supraspinatus tendon tears- anatomical feasibility study. J Exp Orthop 2021; 8:5. [PMID: 33484354 PMCID: PMC7826324 DOI: 10.1186/s40634-021-00326-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The purpose of this study was to investigate the anatomical feasibility of a middle trapezius transfer below the acromion for treatment of irreparable supraspinatus tendon tears. Methods This study involved 20 human cadaveric shoulders in 10 full-body specimens. One shoulder in each specimen was dissected and assessed for muscle and tendon extent, force vectors, and distance to the neurovascular structures. The opposite shoulder was used to evaluate the surgical feasibility of the middle trapezius transfer via limited skin incisions along with an assessment of range of motion and risk of neurovascular injury following transfer. Results The harvested acromial insertion of the middle trapezius tendon showed an average muscle length of 11.7 ± 3.0 cm, tendon length of 2.7 ± 0.9 cm, footprint length of 4.3 ± 0.7 cm and footprint width of 1.4 ± 0.5 cm. The average angle between the non-transferred middle trapezius transfer and the supraspinatus was 33 ± 10° in the transversal plane and 34 ± 14° in the coronal plane. The mean distance from the acromion to the neurovascular bundle was 6.3 ± 1.3 cm (minimum: 4.0 cm). During surgical simulation there was sufficient excursion of the MTT without limitation of range of motion in a retracted scapular position but not in a protracted position. No injuries to the neurovascular structures were noted. Conclusion Transfer of the acromial portion of the middle trapezius for replacement of an irreparable supraspinatus seems to be feasible in terms of size, vector, excursion, mobility and safety. However, some concern regarding sufficiency of transfer excursion remains as scapula protraction can increase the pathway length of the transfer. Level of evidence Basic Science Study/Anatomical Study
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Affiliation(s)
- Philipp Moroder
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
| | - Doruk Akgün
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Lucca Lacheta
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Kathi Thiele
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Marvin Minkus
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Nina Maziak
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Thilo Khakzad
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Christian Festbaum
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Katja Rüttershoff
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Sophia Ellermann
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Torsten Weiss
- Department for Anatomy, Institute for Functional Anatomy, Center for Surgical-anatomical Training, Charité -Universitaetsmedizin Berlin, Berlin, Germany
| | - Thomas Jöns
- Department for Anatomy, Institute for Functional Anatomy, Center for Surgical-anatomical Training, Charité -Universitaetsmedizin Berlin, Berlin, Germany
| | - Victor Danzinger
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
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Kovacevic D, Suriani RJ, Grawe BM, Yian EH, Gilotra MN, Hasan SA, Srikumaran U, Hasan SS, Cuomo F, Burks RT, Green AG, Nottage WM, Theja S, Kassam HF, Saad MA, Ramirez MA, Stanley RJ, Williams MD, Nadarajah V, Konja AC, Koh JL, Rokito AS, Jobin CM, Levine WN, Schmidt CC. Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response. J Shoulder Elbow Surg 2020; 29:2459-2475. [PMID: 32763381 PMCID: PMC7669555 DOI: 10.1016/j.jse.2020.07.030] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no consensus on the treatment of irreparable massive rotator cuff tears. The goal of this systematic review and meta-analysis was to (1) compare patient-reported outcome scores, (2) define failure and reoperation rates, and (3) quantify the magnitude of patient response across treatment strategies. METHODS The MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Scopus databases were searched for studies including physical therapy and operative treatment of massive rotator cuff tears. The criteria of the Methodological Index for Non-randomized Studies were used to assess study quality. Primary outcome measures were patient-reported outcome scores as well as failure, complication, and reoperation rates. To quantify patient response to treatment, we compared changes in the Constant-Murley score and American Shoulder and Elbow Surgeons (ASES) score with previously reported minimal clinically important difference (MCID) thresholds. RESULTS No level I or II studies that met the inclusion and exclusion criteria were found. Physical therapy was associated with a 30% failure rate among the included patients, and another 30% went on to undergo surgery. Partial repair was associated with a 45% retear rate and 10% reoperation rate. Only graft interposition was associated with a weighted average change that exceeded the MCID for both the Constant-Murley score and ASES score. Latissimus tendon transfer techniques using humeral bone tunnel fixation were associated with a 77% failure rate. Superior capsular reconstruction with fascia lata autograft was associated with a weighted average change that exceeded the MCID for the ASES score. Reverse arthroplasty was associated with a 10% prosthesis failure rate and 8% reoperation rate. CONCLUSION There is a lack of high-quality comparative studies to guide treatment recommendations. Compared with surgery, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate.
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Affiliation(s)
- David Kovacevic
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.
| | - Robert J Suriani
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Brian M Grawe
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Edward H Yian
- Kaiser Permanente Southern California, Anaheim, CA, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Samer S Hasan
- MercyHealth/Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH, USA
| | - Frances Cuomo
- Department of Orthopaedic Surgery, Montefiore Medical Center, New York, NY, USA
| | - Robert T Burks
- Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrew G Green
- Department of Orthopaedic Surgery, Warren Alpert Medical School at Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Wesley M Nottage
- The Sports Clinic Orthopaedic Medical Associates, Laguna Hills, CA, USA
| | - Sai Theja
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hafiz F Kassam
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Maarouf A Saad
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | | | | | | | - Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexis C Konja
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jason L Koh
- NorthShore Orthopaedic Institute, NorthShore University Health System, Evanston, IL, USA
| | - Andrew S Rokito
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Christopher C Schmidt
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Arthroscopic-Assisted Lower Trapezius Tendon Transfer for Massive Irreparable Posterosuperior Rotator Cuff Tears Using an Achilles Tendon-Bone Allograft. Arthrosc Tech 2020; 9:e1759-e1766. [PMID: 33294337 PMCID: PMC7695616 DOI: 10.1016/j.eats.2020.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023] Open
Abstract
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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Feasibility of lower trapezius transfer extended by the infraspinatus fascia for restoration of external rotation in irreparable posterosuperior rotator cuff tears: an anatomical study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:661-667. [PMID: 33098460 DOI: 10.1007/s00590-020-02817-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Lower trapezius (LT) transfer using Achilles tendon allograft or semitendinosus autograft is effective in restoring external rotation in massive irreparable posterosuperior rotator cuff tears (RCT). The purpose of this study was to evaluate if the infraspinatus fascia (IF) could be used in LT transfer to extend the LT tendon. METHODS Eight fresh-frozen whole-body cadavers were dissected using both shoulders, beach chair position. A 2.5-3 cm wide bundle of the IF was dissected, from the inferior angle of the scapula up to the insertion of the LT which was then detached subperiosteally in continuity with the fascia. The extended tendon was reinforced with sutures and brought to the center of the footprint of the supraspinatus on the humerus. We measured: (a) the distance between the insertion of the LT on the scapula and the inferior angle of the scapula, estimating the length of the IF that can be harvested, (b) the distance between the insertion of the LT on the scapula and the center of footprint of the infrastinatus on the humerus, estimating the distance needed to be covered by the graft (c) the length of the extended tendon between the center of footprint of the infrastinatus on the humerus (fixation point) and its free end, estimating the length available for fixation. RESULTS The mean length of the fascia that can be harvested is 125.56 mm. The mean distance that needs to be covered by the graft is 100 mm. The extended tendon is long enough leaving 24.69 mm for fixation. CONCLUSIONS The transfer of the LT extended with the IF on the footprint of the infraspinatus is feasible. It could be a viable alternative to the currently used grafts in LT transfer in irreparable posterosuperior RCT.
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Outcome of arthroscopically assisted lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tears. J Shoulder Elbow Surg 2020; 29:2135-2142. [PMID: 32573447 DOI: 10.1016/j.jse.2020.02.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study is to report the outcome of arthroscopically assisted lower trapezius transfer to reconstruct irreparable posterior-superior rotator cuff tear. METHODS Forty-one consecutive patients with irreparable posterior-superior rotator cuff tears who underwent an arthroscopically assisted transfer of the lower trapezius transfer were included in this study. The patients' average age was 52 years (range 37-71), and average follow-up was 14 months (range 6-19 months). Nineteen patients had true pseudoparalysis preoperatively, whereas 66% had a prior failed rotator cuff repair. Outcome measures included visual analog scale (VAS) pain score, range of motion, Subjective Shoulder Value (SSV), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS Thirty-seven (90%) patients had significant improvement of all outcome scores: VAS, SSV, and DASH. The presence of a subscapularis tear did not affect the outcome. However, 3 patients who had preoperative rotator cuff arthropathy changes of the shoulder had persistent pain and limited range of motion of the shoulder after surgery, and 2 of them underwent reverse shoulder arthroplasty. Two additional patients had a traumatic rupture of the transfer as a result of fall (at 5 and 8 months postop). One underwent revision arthroscopic repair and did well after surgery, and the other had good pain relief but recurrent weakness and limited range of motion, and elected not to have a revision surgery. CONCLUSIONS Arthroscopic-assisted lower trapezius transfer may lead to a good outcome in patients with massive irreparable posterior-superior rotator cuff tears, including patients with pseudoparalysis. The presence of an associated reparable subscapularis tear did not affect the outcome.
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Elhassan BT, Wagner ER, Kany J. Latissimus dorsi transfer for irreparable subscapularis tear. J Shoulder Elbow Surg 2020; 29:2128-2134. [PMID: 32573448 DOI: 10.1016/j.jse.2020.02.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
UNLABELLED There is a paucity of information on latissimus dorsi transfer (LDT) for subscapularis insufficiency. The purpose of this study is to report the outcome of LDT to reconstruct an irreparable subscapularis tear. METHODS Excluding patients with prior failed Latarjet procedures, we examined 56 consecutive patients who underwent open (n = 14) or arthroscopic (n = 42) LDT. The average age was 53 years (range, 23-79), and 46 patients had a prior surgery. Outcome measures included visual analog scale score for pain, range of motion (ROM), subjective shoulder value (SSV), and Constant shoulder score (CSS). RESULTS At a mean 13-month follow-up (7-51 months), patients had significant improvements in their pain, ROM, SSV, and CSS when compared to preoperatively. At final follow-up, 26% of patients continued to have proximal migration, and 11% of patients had anterior subluxation. The patients with frank anterior escape had a higher likelihood of having proximal migration and anterior subluxation, but this was not statistically significant. Stages of arthritis did not progress. Revision surgeries included 2 patients who revised to a reverse shoulder arthroplasty for rupture of the tendon transfer. Furthermore, 3 patients had LDT ruptures but did not elect to undergo further surgery. CONCLUSIONS LDT for irreparable subscapularis tears has the potential to lead to significant clinical improvements. Most patients improve in many of the signs of subscapularis insufficiency, including anterior and/or proximal subluxation, clinical examination maneuvers, and shoulder function. Overall, this transfer represents a reasonable option for this difficult pathology.
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Affiliation(s)
| | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Jean Kany
- Department of Orthopaedic Surgery, Clinique de l'Union, Toulouse, France
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Woodmass JM, Wagner ER, Chang MJ, Welp KM, Grubhofer F, Higgins LD, Warner JJP. Arthroscopic lower trapezius tendon transfer provides equivalent outcomes to latissimus dorsi transfer in the treatment of massive posterosuperior rotator cuff tears. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wagner ER, Elhassan BT. Surgical Management of Massive Irreparable Posterosuperior Rotator Cuff Tears: Arthroscopic-Assisted Lower Trapezius Transfer. Curr Rev Musculoskelet Med 2020; 13:592-604. [PMID: 32661919 DOI: 10.1007/s12178-020-09657-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF THE REVIEW Functionally irreparable rotator cuff tears (FIRCTs) remain one of the most challenging pathologies treated in the shoulder. The lower trapezius transfer represents a very promising treatment option for posterosuperior FIRCT. This article reviews the role for the lower trapezius transfer in the treatment of patient with FIRCTs and highlights the tips and tricks to performing this arthroscopic-assisted procedure. RECENT FINDINGS The treatment of posterosuperior FIRCTs contemplates a wide array of surgical options, including partial repair, biceps tenodesis/tenotomy, superior capsule reconstruction, subacromial balloon, reverse shoulder arthroplasty, and open-/arthroscopic-assisted tendon transfers. Tendon transfers have emerged as very promising reconstructive options to rebalance the anterior-posterior force couple. Controversy remains regarding the relative indications of latissimus dorsi transfer (LDT) and lower trapezius transfer (LTT). Initially used with very good success in patients with brachial plexus injuries, the open LTT has shown excellent clinical and radiographic outcomes in a recent series of patients with FIRCTs. However, this technique should be reserved for patients with an intact or reparable subscapularis tendon and no advanced glenohumeral arthritis or humeral head femoralization. With advancements in surgical technique, the arthroscopic-assisted LTT has shown similar promising results. However, studies on arthroscopically assisted LTT are limited to short-term follow-up, and future comparative trials with large patient numbers and longer follow-up are needed to better understand the indications for this novel tendon transfer in the treatment of FIRCT. The arthroscopic-assisted LTT is a novel, promising option for the treatment of patients with functional irreparable posterosuperior rotator cuff tears. Careful attention to indications and technical pearls are paramount when performing this procedure to optimize postoperative clinical outcomes.
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Affiliation(s)
- Eric R Wagner
- Department of Orthopaedic Surgery, Division of Upper Extremity Surgery, Emory University, Atlanta, GA, 30329, USA.
| | - Bassem T Elhassan
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
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Makki D, Tang QO, Sandher D, Morgan BW, Ravenscroft M. Arthroscopic Superior Capsular Reconstruction of the Shoulder Using Dermal Allograft. Orthopedics 2020; 43:215-220. [PMID: 32379339 DOI: 10.3928/01477447-20200428-05] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/24/2020] [Indexed: 02/03/2023]
Abstract
Irreparable massive cuff tears in young patients pose a difficult problem for shoulder surgeons. Arthroscopic superior capsular reconstruction has shown promise in recent years in the treatment of this challenging patient population. The majority of the literature is limited to surgical techniques. The authors present the 2-year clinical outcomes of 25 patients undergoing arthroscopic superior capsular reconstruction with dermal allograft from a single center. The Oxford Shoulder Score and range of motion were assessed preoperatively and then at 3 to 6 months, 1 year, and 2 years following surgery. Patient satisfaction was recorded at final follow-up. Magnetic resonance imaging was performed at 3 months postoperatively to assess graft integrity. All patients were available at 1-year follow-up, and 23 were available at 2 years. The mean Oxford Shoulder Score improved by a minimum of 10 points at all time points compared with preoperatively. The mean forward flexion and abduction improved by 20° and external rotation by 7°. Revision to reverse shoulder arthroplasty was seen in 3 patients (12%). Graft failure was seen in 4 patients (16%). Overall, 20 patients had successful outcomes at 1 year (80%) and 18 patients had successful outcomes at 2 years (72%). Superior capsular reconstruction offers a safe and effective short-term bridging option for young patients with irreparable supraspinatus tears in the absence of glenohumeral arthritis. However, long-term outcome studies are required to evaluate the true clinical effectiveness and failure rates. [Orthopedics. 2020;43(4):215-220.].
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Checchia C, Domos P, Grimberg J, Kany J. Current Options in Tendon Transfers for Irreparable Rotator Cuff Tears. JBJS Rev 2020; 7:e6. [PMID: 30817693 DOI: 10.2106/jbjs.rvw.18.00044] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Peter Domos
- The Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Jean Grimberg
- Institut de recherche en chirurgie orthopédique sportive, Clinique Remusat, Paris, France
| | - Jean Kany
- Toulouse Shoulder Unit, Clinique de l'Union, Saint Jean, France
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Kim J, Ryu Y, Kim SH. Surgical Options for Failed Rotator Cuff Repair, except Arthroplasty: Review of Current Methods. Clin Shoulder Elb 2020; 23:48-58. [PMID: 33330234 PMCID: PMC7714325 DOI: 10.5397/cise.2019.00416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/30/2019] [Accepted: 01/08/2020] [Indexed: 12/30/2022] Open
Abstract
Although the prevalence of rotator cuff tears is dependent on the size, 11% to 94% of patients experience retear or healing failure after rotator cuff repair. Treatment of patients with failed rotator cuff repair ranges widely, from conservative treatment to arthroplasty. This review article attempts to summarize the most recent and relevant surgical options for failed rotator cuff repair patients, and the outcomes of each treatment, except arthroplasty.
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Affiliation(s)
- Jangwoo Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yunki Ryu
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Kany J, Sekaran P, Grimberg J, Amavarathi RS, Valenti P, Elhassan B, Werthel JD. Risk of latissimus dorsi tendon rupture after arthroscopic transfer for posterior superior rotator cuff tear: a comparative analysis of 3 humeral head fixation techniques. J Shoulder Elbow Surg 2020; 29:282-290. [PMID: 31473133 DOI: 10.1016/j.jse.2019.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND To compare latissimus dorsi tendon rupture rates after arthroscopic transfer for posterior superior rotator cuff tear using 3 different humeral head fixation techniques. METHODS One-hundred fifty consecutive latissimus dorsi transfers were included. Inclusion criteria were massive irreparable posterosuperior rotator cuff tear with advanced fatty infiltration associated with persistent pain and limited range of motion after failed conservative treatments or surgery. All transfers were arthroscopically assisted and fixed in a transosseous tunnel with a cortical button (group 1, n = 59), "over the top" onto the footprint of the supraspinatus (group 2, n = 47), or posteriorly onto the footprint of the infraspinatus (group 3, n = 44) with 2 suture anchors. The tendons were marked with 3 metallic clips placed intraoperatively at a fixed distance of 2, 4, and 6 cm from the tip. Immediate postoperative standard anteroposterior radiographs were performed to confirm the position of the clips and to determine whether the clips displaced on subsequent radiographs during follow-up, indicating tendon rupture. RESULTS Repeat radiographs at 3-month follow-up showed higher risk of latissimus dorsi transfer rupture rate in 27/59 patients in group 1 (46%), 11/47 in group 2 (24%), and 7/44 in group 3 (15%). CONCLUSION Posterior anchor fixation of the latissimus dorsi tendon onto the infraspinatus footprint had the lowest rupture rate.
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Affiliation(s)
- Jean Kany
- Shoulder Department, Clinique de l'Union, Ramsay GDS, Saint Jean, France.
| | | | - Jean Grimberg
- Shoulder Department, LIRCOS, Clinique Jouvenet, Ramsay GDS, Paris, France
| | - Rajkumar S Amavarathi
- Division of Arthroscopy and Sports Surgery, Department of Orthopaedics, St John's Medical College and Hospital, Bangalore, Karnataka, India
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Low level of evidence for all treatment modalities for irreparable posterosuperior rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2019; 27:4038-4048. [PMID: 31535193 DOI: 10.1007/s00167-019-05710-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/11/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE This systematic review assesses evidence for improvements in outcome for all reported types of treatment modalities [physical therapy, tenotomy or tenodesis of the long head of the biceps, debridement, partial repair, subacromial spacer, deltoid flap, muscle transfer, rotator cuff advancement, graft interposition, superior capsular reconstruction (SCR), and reversed shoulder arthroplasty (RSA)] used for irreparable posterosuperior rotator cuff tears without glenohumeral osteoarthritis. The primary aim was to be able to inform patients about expectations of the amount of clinical improvement after these treatments. METHODS A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and Cochrane databases for studies on irreparable posterosuperior rotator cuff lesions without glenohumeral osteoarthritis, published from January 2007 until January 2019, with minimum 2-year follow-up. Studies with pre-operative and/or intra-operative determination of cuff tear irreparability were included. We defined the non-adjusted Constant Score as the primary outcome. RESULTS Sixty studies (2000 patients) were included with a fair mean quality score, according to the Modified Coleman Methodology Score. The employed definitions of 'irreparable' were mainly based on MRI criteria and were highly variable among studies. The smallest weighted mean preoperative to post-operative improvements in Constant Score were reported for biceps tenotomy/tenodesis (10.7 points) and physical therapy (13.0). These were followed by debridement (21.8) and muscle transfer (27.8), whereas the largest increases were reported for partial repair (32.0), subacromial spacer (32.5), rotator cuff advancement (33.2), RSA (34.4), graft reconstruction (35.0), deltoid flap (39.8), and SCR (47.4). Treatment using deltoid flap showed highest mean weighted improvement in Constant Score among studies with available medium-term (4-5-year) follow-up. Treatments deltoid flap, muscle transfer, and debridement were the only treatments with available long-term (8-10-year) follow-up and showed similar improvements in Constant Score at this time point. CONCLUSION The variability in patient characteristics, co-interventions, outcome reporting, and length of follow-up in studies on irreparable rotator cuff tears without osteoarthritis complicates sound comparison of treatments. Clinically important treatment effects were seen for all 11 different treatment modalities. LEVEL OF EVIDENCE IV.
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Polacek M. Arthroscopic Superior Capsular Reconstruction With Acellular Porcine Dermal Xenograft for the Treatment of Massive Irreparable Rotator Cuff Tears. Arthrosc Sports Med Rehabil 2019; 1:e75-e84. [PMID: 32266343 PMCID: PMC7120814 DOI: 10.1016/j.asmr.2019.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/17/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose To evaluate the short-term clinical outcomes and the complications related to arthroscopic superior capsular reconstruction (SCR) with acellular porcine dermal xenograft for the treatment of irreparable massive rotator cuff tears. Methods A prospective observational study of patients treated with arthroscopic SCR for irreparable massive rotator cuff tears in the period from 2016 to 2017 was performed. Range of motion and Shoulder Pain and Disability Index (SPADI) scores were assessed preoperatively, at 6 months postoperatively, and at 12 months postoperatively. Results A total of 20 shoulders in 19 patients, with an average age of 60 years, were included in the study. Twelve patients met the criterion for the minimal clinically important difference in the SPADI score. The mean SPADI score showed significant improvement from 51.3% to 10.4% at 1-year follow-up. Active abduction improved from 65.4° to 149.3° and active forward flexion improved from 68.6° to 151.4° at 1-year follow-up. The procedure had a 30% complication rate, including a 15% rate of immunologic rejection of the xenograft. Five patients underwent revision procedures, including arthroscopic debridement and removal of xenograft residuals, implantation of a balloon spacer, and revision SCR with a fascia lata autograft. Conclusions Arthroscopic SCR with an acellular porcine dermal xenograft led to a successful outcome in 60% of cases. The procedure showed a quite high complication rate; the most severe cases were related to acute immunologic rejection of the xenograft. Level of Evidence Level IV, case series.
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Affiliation(s)
- Martin Polacek
- Address correspondence to Martin Polacek, M.D., Ph.D., Orthopedic Department, Drammen Hospital, Vestre Viken Hospital Trust, 3004 Drammen, Norway.
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Woodmass JM, Wagner ER, Chang MJ, Welp KM, Elhassan BT, Higgins LD, Warner JJP. Arthroscopic Treatment of Massive Posterosuperior Rotator Cuff Tears: A Critical Analysis Review. JBJS Rev 2019; 6:e3. [PMID: 30204644 DOI: 10.2106/jbjs.rvw.17.00199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jarret M Woodmass
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric R Wagner
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Michelle J Chang
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathryn M Welp
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Jon J P Warner
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
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Burnier M, Elhassan BT, Sanchez-Sotelo J. Surgical Management of Irreparable Rotator Cuff Tears: What Works, What Does Not, and What Is Coming. J Bone Joint Surg Am 2019; 101:1603-1612. [PMID: 31483405 DOI: 10.2106/jbjs.18.01392] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Woodmass JM, Wagner ER, Borque KA, Chang MJ, Welp KM, Warner JJP. Superior capsule reconstruction using dermal allograft: early outcomes and survival. J Shoulder Elbow Surg 2019; 28:S100-S109. [PMID: 31196503 DOI: 10.1016/j.jse.2019.04.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsule reconstruction (SCR) has shown promising outcomes in its initial description, but lacks additional reports analyzing outcomes. This study analyzes early outcomes of SCRs in patients with massive irreparable rotator cuff tears. METHODS A retrospective analysis of all SCRs at our institution from January 1, 2015, to August 31, 2017, was performed with a minimum 6-months follow-up. A total of 34 patients were included with a mean age of 60 years. SCR was performed by 1 of 6 fellowship trained surgeons. RESULTS At an average follow-up of 12 months, 22 patients were identified as failures after modified Neer classification. Furthermore, 8 of these patients have undergone a reoperation, whereas an additional 14 patients were considered clinical failures experiencing continued pain and a lack of shoulder function. Of note, 2 of the 3 patients with a subscapularis tear had a failure. In addition, revision cases, female gender, increased fatty infiltration in the infraspinatus and low surgeon volume were associated with a higher rate of failure. There was no significant improvement in range of motion or functional scores. CONCLUSION SCR performed for large-to-massive irreparable rotator cuff tears has a high rate of persistent pain and poor function leading to clinical failure in 65% of patients. Risk factors predicting clinical failure included revision cases, female gender, increased Goutallier fatty infiltration of the infraspinatus, and low surgeon volume (n ≤ 10).
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Affiliation(s)
| | - Eric R Wagner
- Department of Orthopedic Surgery, Emory University, Atlanta, GA, USA
| | - Kyle A Borque
- Boston Shoulder Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle J Chang
- Boston Shoulder Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Kathryn M Welp
- Boston Shoulder Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Jon J P Warner
- Boston Shoulder Institute, Massachusetts General Hospital, Boston, MA, USA.
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Lim TK, Bae KH. Arthroscopic-assisted Latissimus Dorsi Tendon Transfer for the Management of Irreparable Rotator Cuff Tears in Middle-aged Physically Active Patients. Clin Shoulder Elb 2019; 22:9-15. [PMID: 33330188 PMCID: PMC7713881 DOI: 10.5397/cise.2019.22.1.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/21/2018] [Accepted: 12/02/2018] [Indexed: 11/25/2022] Open
Abstract
Background Latissimus dorsi (LD) tendon transfer is used as a treatment option for massive irreparable posterosuperior rotator cuff tears, and recently, an arthroscopic-assisted technique was introduced. This study was undertaken to evaluate the clinical and radiological outcomes of arthroscopic-assisted LD tendon transfer for the management of irreparable rotator cuff tears in active middle-aged patients. Methods The records of five patients (two males) with irreparable tears involving the supraspinatus and infraspinatus tendons managed by arthroscopic-assisted LD tendon transfer were retrospectively reviewed. Clinical outcomes were assessed using the visual analogue scale (VAS) pain scale, American Shoulder and Elbow Surgeon’s (ASES) scores, the University of California Los Angeles (UCLA) scale, and ranges of motion. Postoperative integrities of transferred tendon were evaluated by magnetic resonance imaging in 4 patients and by ultrasound in one. Results Mean patient age was 55 years (range, 48–61 years), and mean follow-up period was 20 months (range, 12.0–27.2 months). Mean VAS score significantly improved from 6.6 ± 2.6 preoperatively to 1.8 ± 2.5 postoperatively (p=0.009), mean ASES score increased from 67.6 ± 9.2 to 84.6 ± 15.1, and mean UCLA score from 18.0 ± 1.4 to 28.8 ± 8.5 (all p<0.001). Postoperative imaging of the transferred LD tendon showed intact repair in 4 patients. The remaining patient experienced LD transfer rupture and a poor outcome. Conclusions Arthroscopic-assisted LD tendon transfer improved shoulder pain and function in patients with massive, irreparable rotator cuff tears, and may be an option for this condition, especially in physically active patients.
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Affiliation(s)
- Tae Kang Lim
- Department of Orthopedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Kyu Hwan Bae
- Department of Orthopedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
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Osti L, Buda M, Andreotti M, Gerace E, Osti R, Massari L, Maffulli N. Arthroscopic-assisted latissimus dorsi transfer for massive rotator cuff tear: a systematic review. Br Med Bull 2018; 128:23-35. [PMID: 30137207 DOI: 10.1093/bmb/ldy030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/28/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION This systematic review provides a comprehensive description of different surgical techniques for massive rotator cuff tears (MRCTs) using arthroscopic-assisted latissimus dorsi transfer (A-LDT), reporting clinical outcomes and complications. SOURCES OF DATA We searched the literature on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'latissimus dorsi', 'tendon', 'transfer', 'rotator cuff tears', 'shoulder' and 'arthroscopy' to identify articles published in English, Spanish, French and Italian. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed for the manuscript selection. AREAS OF AGREEMENT Ten studies (five retrospective and five prospective investigations), all published between 2014 and 2018, fulfilled our inclusion criteria, dealing with 348 (55.7% male) patients, with a mean age of 61.6 years (range 31-83). AREAS OF CONTROVERSY A-LDT is a technical demanding procedure. When compared with the open technique, it does not seem to provide significant subjective and objective clinical outcome improvements. GROWING POINTS A-LDT seems to yield lesser surgical complications and post-operative stiffness. Sparing the deltoid muscle belly could result in a more effective shoulder post-surgery function. AREAS TIMELY FOR DEVELOPING RESEARCH Further comparative randomized controlled trials with longer follow-up are needed to clarify the potentially promising superiority of A-LDT.
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Affiliation(s)
- Leonardi Osti
- Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Via Arqua', Modena, Italy
| | - Matteo Buda
- Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Via Arqua', Modena, Italy
| | - Mattia Andreotti
- Department of Trauma and Orthopaedic Surgery, University of Ferrara, S.Anna Hospital, Via Aldo Moro, Ferrara, Italy
| | - Emanuele Gerace
- Department of Trauma and Orthopaedic Surgery, University of Ferrara, S.Anna Hospital, Via Aldo Moro, Ferrara, Italy
| | - Raffaella Osti
- Department of Trauma and Orthopaedic Surgery, University of Ferrara, S.Anna Hospital, Via Aldo Moro, Ferrara, Italy
| | - Leo Massari
- Department of Trauma and Orthopaedic Surgery, University of Ferrara, S.Anna Hospital, Via Aldo Moro, Ferrara, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno, Italy.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke on Trent, UK.,Centre for Sport and Exercise Medicine, Queen Mary University of London, London, UK
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Lower trapezius transfer with semitendinosus tendon augmentation: Indication, technique, results. ACTA ACUST UNITED AC 2018; 13:261-268. [PMID: 30546490 PMCID: PMC6267376 DOI: 10.1007/s11678-018-0495-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/09/2018] [Indexed: 11/29/2022]
Abstract
Background Lower trapezius transfer can restore external rotation in brachial plexus palsies. In some cuff tear arthropathies, there is lack of active external rotation with a preservation of forward elevation. We evaluated the clinical outcomes of a lower trapezius transfer extended with a semitendinosus tendon and fixed to the insertion of the infraspinatus via arthroscopy. Methods Between 2013 and 2016, we operated on 14 patients (8 men, 6 women; mean age of 62 years, range: 50–70) to reconstruct irreparable posterosuperior rotator cuff tear. A vertical incision of 6 cm following the medial border of the spine was made to harvest the lower trapezius in extension with the semitendinosus tendon. The extension band of the lower trapezius was fixed laterally via arthroscopy on the great tuberosity at the level of the insertion of the infraspinatus. The proximal stump of this extension band was then fixed medially into the muscle of the lower trapezius with the arm in maximum external rotation. Outcomes were evaluated with the Constant–Murley score, simple shoulder test (SST), and subjective shoulder value (SSV). Results Over a mean follow-up of 24 months (range: 12–36 months), the gain in external rotation with the arm at the side was 24° and 40° in 90° of abduction. The Constant–Murley score improved from 35 to 60 points, the SST from 3.5 to 7.5, the SSV from 30 to 60%, and the pain decreased from 7 to 2 (visual analogue scale, 0–10). Both the lag sign and hornblower sign were negative after this transfer. There were two cases of hematomas, and one was revised because of infection. Conclusion Lower trapezius transfer is a therapeutic option for irreparable posterosuperior cuff tears with a lack of active external rotation and a good subscapularis. Patients can expect improvements in pain and in active external rotation without any loss of active anterior elevation.
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