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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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Jeske HC, Tauber M, Wambacher M, Perwanger F, Liebensteiner M, Kralinger F. Clinical outcomes in latissimus dorsi transfer single- versus double-incision technique. Arch Orthop Trauma Surg 2023; 143:1741-1751. [PMID: 34994856 DOI: 10.1007/s00402-021-04291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 11/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND/HYPOTHESIS In patients with irreparable postero-superior rotator cuff lesions, a latissimus dorsi transfer (LDT) is performed. For this surgery, different techniques are used. In this study, we aim to compare the patient's functional outcome after treatment with modified L'Episcopo "single-incision" and modified Gerber "double-incision" technique for LDT. METHODS 44 patients with irreparable postero-superior rotator cuff ruptures, refractory to physiotherapeutic treatment were included. 21 patients were treated using a modified L'Episcopo "single-incision", 23 patients with modified Gerber "double-incision" surgical approach. All patients had full-thickness tears of at least two complete tendons, and all had fully functioning deltoid and subscapularis muscles. Preoperatively, there were statistically significant differences between the two groups in all preoperative CMS sub-parameters except "power" and "pain". In the postoperative follow-up, a functional assessment using "Constant-Murley Score" (CMS) and "Age- and gender-related CMS" was conducted. STUDY DESIGN Retrospective-comparative trial. LEVEL OF EVIDENCE III RESULTS There were no statistically significant differences between age, sex and time of follow-up between the two study groups (p > 0.05). The mean age was 59.2(± 6.3) years, and the mean follow-up time was 45.4(± 9.3) months for both groups taken together. Mean CMS improved for both groups together from 24.2 ± 8.2 points prior to surgery, to 62.8 ± 17.4 points after a mean follow-up time of 45.4 ± 9.3 months post surgery. The patients treated with "single-incision" surgery (n = 21) gained significantly (p < 0.001) more in CMS and all CMS-sub-scoring parameters except power and pain, compared to the patients treated with "double-incision" technique (n = 23). CONCLUSION This survey shows appealing post-operative functional outcome in patients with irreparable postero-superior rotator cuff lesions treated with two different techniques for LDT. We believe that the presentation of these methods and their results might encourage shoulder surgeons to implement these techniques. Especially the "single-incision" LDT surgery might be a more accustomed technique for many shoulder surgeons well trained in the deltopectoral approach.
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Affiliation(s)
- Hans-Christian Jeske
- Department of Traumatology and Orthopedics, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
- Orthoplus, Talfergasse 2, 39100, Bolzano, Italy.
| | - Mark Tauber
- ATOS Clinic, Effnerstraße 38, 81925, Munich, Germany
- Department of Traumatology and Orthopedics, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Markus Wambacher
- Department of Traumatology and Orthopedics, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Michael Liebensteiner
- Department of Traumatology and Orthopedics, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Franz Kralinger
- Department of Traumatology, Clinic Ottakring, Montleartstrasse 37, 1160, Vienna, Austria
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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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Velasquez Garcia A, Osorio Valdivia P, Brito Ayet C, Mendez M. Latissimus Dorsi Transfer Combined with Subacromial Balloon Spacer for Bidirectional Rotator Cuff Deficiency. Arthrosc Tech 2022; 11:e2327-e2335. [PMID: 36632392 PMCID: PMC9827003 DOI: 10.1016/j.eats.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with massive, irreparable rotator cuff tears represent a challenge for treatment, particularly those with loss of external rotation and active elevation. In the cases of glenohumeral arthropathy, reverse shoulder arthroplasty combined with transfer of the latissimus dorsi and teres major tendons has improved active external rotation and overall patient outcomes. However, the reverse shoulder prosthesis could be better used as a second-line treatment in patients without arthropathy. Several joint-preserving surgical approaches have been described for irreparable cuff tears with no substantial differences in results. Although latissimus dorsi transfer has shown long-term clinical reliability and improved functional shoulder function in relatively young patients, isolated tendon transfer appears insufficient to restore range of motion in patients with a bidirectional deficit. The subacromial balloon spacer is an additional new treatment option. This surgical procedure describes an arthroscopic-assisted transfer of the latissimus dorsi tendon followed by the implantation of the subacromial balloon. This combination potentially addresses the bidirectional deficiency by restoring the shoulder external rotational coupling, improving the deltoid load, centering the humeral head, and protecting the transferred tendon from the subacromial compression stresses.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Clinica Universidad de Los Andes, Santiago, Chile,Department of Orthopedic Surgery, Hospital Militar de Santiago, Santiago, Chile,Address correspondence to Ausberto Velasquez Garcia, M.D., Clinica Universidad de Los Andes, Av. Plaza 2501, Las Condes, Santiago 7620157, Chile.
| | | | - Cristián Brito Ayet
- Orthopaedic Department, Hospital Naval de Chile, Viña del Mar, Santiago, Chile
| | - Magdalena Mendez
- Resident of Orthopedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Lubowitz JH, Brand JC, Rossi MJ. Early Treatment of Shoulder Pathology Is Necessary but Not Enough Is Being Performed. Arthroscopy 2022; 38:2943-2953. [PMID: 36344053 DOI: 10.1016/j.arthro.2022.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Delayed treatment of shoulder instability results in bone loss requiring more-complicated surgery, in turn resulting in less-optimal outcomes. Similarly, delayed treatment of repairable rotator cuff tears results in irreparable tears requiring more-complicated surgery and resulting in less-optimal outcomes. Delayed treatment of shoulder pathology is a problem. Solutions include education and research investigation.
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Berthold DP, Muench LN, Elhassan BT. How the Biomechanical Complexity of Tendon Transfers in Shoulder Surgery is Still Robbing us of Sleep in 2021. Arthroscopy 2021; 37:2026-2028. [PMID: 34225995 DOI: 10.1016/j.arthro.2021.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Bassem T Elhassan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Treatment of Patients with Rotator Cuff Injuries (Review of Literature). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2020-5.6.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kia C, Muench LN, Williams AA, Avery DM, Cote MP, Reed N, Arciero RA, Chandawarkar R, Mazzocca AD. Author Reply to "Regarding 'High Clinical Failure Following Latissimus Dorsi Transfer for Revision Massive Rotator Cuff Tears'". Arthroscopy 2020; 36:2350-2351. [PMID: 32891238 DOI: 10.1016/j.arthro.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Cameron Kia
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Lukas N Muench
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Ariel A Williams
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | | | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Nicholas Reed
- Associates in Orthopedics and Sports Medicine, Dalton, Georgia, U.S.A
| | - Robert A Arciero
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | | | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
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Neviaser RJ. Regarding "High Clinical Failure Rate After Latissimus Dorsi Transfer for Revision Massive Rotator Cuff Tears". Arthroscopy 2020; 36:2350. [PMID: 32891239 DOI: 10.1016/j.arthro.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Robert J Neviaser
- Professor Emeritus of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC, U.S.A
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Letter regarding article by Clavert et al.: long-term outcomes of latissimus dorsi transfer for irreparable rotator cuff tears. INTERNATIONAL ORTHOPAEDICS 2020; 44:1441-1442. [PMID: 32363410 DOI: 10.1007/s00264-020-04588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
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