1
|
Reid JJ, Garrigues GE, Friedman RJ, Eichinger JK. Irreparable Subscapularis Tears: Current Tendon Transfer Options. Curr Rev Musculoskelet Med 2024; 17:68-75. [PMID: 38182803 PMCID: PMC10847079 DOI: 10.1007/s12178-023-09881-9] [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] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE OF REVIEW Irreparable subscapularis tears, especially in younger patients with higher functional demands, present a challenging entity. Pectoralis major and latissimus dorsi tendon transfers are commonly considered for surgical management of this pathology, yet no consensus exists regarding the superior option. The purpose of this article is to review the most current tendon transfer techniques for irreparable subscapularis tears. RECENT FINDINGS For decades, transfer of the pectoralis major has been considered the gold standard technique for irreparable subscapularis tears. This transfer was found to reduce pain and improve functional outcome scores, yet range of motion and force of internal rotation were not maintained in long-term follow-up studies. The latissimus dorsi tendon transfer for the same indications has demonstrated biomechanical superiority in recent cadaveric studies with promising short-term results clinically. Both pectoralis major and latissimus dorsi tendon transfers improve outcomes of patients with irreparable subscapularis tears. Future comparative studies are still needed to determine superiority amongst techniques.
Collapse
Affiliation(s)
- Jared J Reid
- Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston SC 29412, Clinical Science Building MSC, Code 708, Charleston, SC, USA.
| | | | - Richard J Friedman
- Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston SC 29412, Clinical Science Building MSC, Code 708, Charleston, SC, USA
| | - Joseph K Eichinger
- Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston SC 29412, Clinical Science Building MSC, Code 708, Charleston, SC, USA
| |
Collapse
|
2
|
Valenti P. Surgical procedure to restore shoulder external rotation in post-traumatic brachial plexus lesions in adults. HAND SURGERY & REHABILITATION 2021; 41S:S39-S43. [PMID: 34407484 DOI: 10.1016/j.hansur.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 10/20/2022]
Abstract
The lack of active external rotation following a brachial plexus injury in adults is very disabling and very challenging to solve. If direct nerve surgery or nerve transfer fails or if the patient is seen too late, palliative surgery is the last resort. Shoulder fusion can stabilize the joint to increase strength at the elbow, but the patient loses all external rotation. A metaphyseal humeral osteotomy shifts the sector of mobility to push out the arm from the chest but does not restore any active external rotation. Latissimus dorsi and teres major transfers are not indicated in traumatic brachial plexus injuries. Lower trapezius (inferior fibers of the trapezius) transfer detached from the medial angle of the scapula and fixed to the infraspinatus tendon is the main option in paralyzed shoulders. It can restore 90° external rotation on average. This tendon transfer is an agonist, with the same direction but with less excursion and strength. If this muscle is paralyzed (nerve lesion), one can harvest and transfer the contralateral lower trapezius instead. The goals of this paper are to describe the surgical technique for these two tendons transfer, their indications and results.
Collapse
Affiliation(s)
- P Valenti
- Institut de la Main, Paris Shoulder Unit, Clinique Bizet, 23, Rue Georges Bizet, 75116 Paris, France.
| |
Collapse
|
3
|
Burnier M, Lafosse T. Pectoralis Major and Anterior Latissimus Dorsi Transfer for Subscapularis Tears. Curr Rev Musculoskelet Med 2020; 13:725-733. [PMID: 32833188 DOI: 10.1007/s12178-020-09674-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Irreparable subscapularis tears represent a challenging entity, especially when they occur in younger patients with high functional demands. Tendon transfers are one of the options considered for surgical management for this pathology. The purpose of this article is to review the surgical technique and outcome of the two most common tendon transfers considered for irreparable subscapularis tears: pectoralis major and latissimus dorsi. RECENT FINDINGS Transfer of the pectoralis major has been considered for decades the transfer of choice for irreparable subscapularis tears. Recently, a series with long-term follow-up (over 18 years) supported the reduction in pain and improvement in functional scores and patient satisfaction after pectoralis major transfer. However, the range of motion and the force in internal rotation were not maintained over time. Transfer of the latissimus dorsi to the lesser tuberosity has been recently described as an alternative with a sound biomechanical rationale and encouraging short-term results. Transfer of the pectoralis major and the transfer of latissimus dorsi to the lesser tuberosity are the two transfers most commonly considered for patients with irreparable subscapularis tears. Transfer of the pectoralis major has a much longer track record. Both procedures seem to improve outcomes. Comparative studies are needed to determine the relative indications of these two procedures.
Collapse
Affiliation(s)
- Marion Burnier
- Hand and Upper Extremity Surgical Institute, Clinique du Medipole, 17 avenue Condorcet, Villeurbanne, France.
| | - Thibault Lafosse
- Alps Surgery Institute: Hand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Clinique Générale d'Annecy, Annecy, France
| |
Collapse
|
4
|
Gil-Álvarez JJ, García-Parra P, Anaya-Rojas M, Martínez-Fuentes MDP. Contralateral trapezius transfer to treat scapular winging: A case report and review of literature. World J Orthop 2019; 10:33-44. [PMID: 30705839 PMCID: PMC6354107 DOI: 10.5312/wjo.v10.i1.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/17/2018] [Accepted: 12/17/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND No dynamic technique, such as tendon transfer, has been described for scapular winging due to levator scapulae or rhomboid major and minor palsies resulting from an isolated dorsal scapular nerve injury. Thus, we evaluated how the contralateral trapezius compound osteomuscular flap transfer would work in stabilizing lateral scapular winging, and the case is reported here. A literature review was also conducted, and articles relevant to the case are presented.
CASE SUMMARY A 37-year-old male patient who had sustained an isolated dorsal scapular nerve injury underwent reconstructive surgery using the contralateral trapezius compound osteomuscular flap transfer technique to treat scapular winging and the consequent pain, and to restore function from the shoulder impairment. As a result, the involved shoulder showed an improved Constant-Murley score, from 19.5% to 81.88%.
CONCLUSION Contralateral trapezius osteomuscular flap transfer succeeded in stabilizing scapular winging in this case, improving shoulder function and affording pain relief.
Collapse
Affiliation(s)
- Juan José Gil-Álvarez
- Department of Orthopedics and Traumatology, Hospital Universitario Virgen del Rocío, Sevilla 41013, Spain
| | - Pablo García-Parra
- Department of Orthopedics and Traumatology, Hospital Universitario Virgen del Rocío, Sevilla 41013, Spain
| | - Manuel Anaya-Rojas
- Department of Orthopedics and Traumatology, Hospital Universitario Virgen del Rocío, Sevilla 41013, Spain
| | | |
Collapse
|
5
|
Wyles CC, Maldonado AA, Wagner ER, Houdek MT, Lachman N, Spinner RJ. Proposed surgical technique to facilitate targeted reinnervation of the infraspinatus: A cadaveric feasibility study. Clin Anat 2018; 32:131-136. [DOI: 10.1002/ca.23310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Cody C. Wyles
- Mayo Clinic Department of Orthopedic Surgery; Rochester Minnesota
| | - Andrés A. Maldonado
- BG Unfallklinik Frankfurt am Main Department of Plastic Surgery; Frankfurt Germany
| | - Eric R. Wagner
- Mayo Clinic Department of Orthopedic Surgery; Rochester Minnesota
| | | | - Nirusha Lachman
- Mayo Clinic Department of Anatomy; Rochester Minnesota
- Mayo Clinic Department of Plastic Surgery; Rochester Minnesota
| | - Robert J. Spinner
- Mayo Clinic Department of Orthopedic Surgery; Rochester Minnesota
- Mayo Clinic Department of Anatomy; Rochester Minnesota
- Mayo Clinic Department of Neurologic Surgery; Rochester Minnesota
| |
Collapse
|
6
|
Anastasopoulos PP, Alexiadis G, Spyridonos S, Fandridis E. Latissimus Dorsi Transfer in Posterior Irreparable Rotator Cuff Tears. Open Orthop J 2017; 11:77-94. [PMID: 28400877 PMCID: PMC5366394 DOI: 10.2174/1874325001711010077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/09/2016] [Accepted: 04/20/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Massive rotator cuff tears pose a difficult and complex challenge even for the experienced surgeon; inability to repair these tears by conventional means designates them as irreparable, while management becomes quite taxing. Several operative options have been suggested for the management of such lesions with varying degrees of success, while it is imperative to match patient demands and expectations to the predicted outcome. METHODS Research articles are examined and key concepts are discussed, in order to provide an evidence based review of the available literature. The anatomy and pathomechanics along with the indications, contraindications and surgical techniques are reported. RESULTS Transfer of the Latissimus dorsi has been used with success to restore shoulder function in deficits of the posterior rotator cuff. Although it can be used in a variety of settings, the ideal patient for a Latissimus dorsi tendon transfer is a young and active individual, with no glenohumeral osteoarthritis that has a severe disability and weakness related to an irreparable posterior cuff tear. CONCLUSION Tendon transfers have proved to be a successful treatment option in salvaging this difficult problem, providing pain relief and restoring shoulder function. Despite the excellent functional outcomes and pain suppression following operation, a variety of factors may affect the outcome; thus making indications and preoperative assessment a valuable component.
Collapse
Affiliation(s)
- Panagiotis P Anastasopoulos
- Hand Surgery-Upper Limb and Microsurgery Department, KAT General Hospital, Nikis 2 Str, Kifisia 145-61, Athens, Greece
| | - George Alexiadis
- Hand Surgery-Upper Limb and Microsurgery Department, KAT General Hospital, Nikis 2 Str, Kifisia 145-61, Athens, Greece
| | - Sarantis Spyridonos
- Hand Surgery-Upper Limb and Microsurgery Department, KAT General Hospital, Nikis 2 Str, Kifisia 145-61, Athens, Greece
| | - Emmanouil Fandridis
- Hand Surgery-Upper Limb and Microsurgery Department, KAT General Hospital, Nikis 2 Str, Kifisia 145-61, Athens, Greece
| |
Collapse
|
7
|
Elhassan BT, Wagner ER, Werthel JD. Outcome of lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear. J Shoulder Elbow Surg 2016; 25:1346-53. [PMID: 26968088 DOI: 10.1016/j.jse.2015.12.006] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/26/2015] [Accepted: 12/04/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Management of massive irreparable posterior-superior rotator cuff tear can be very challenging. This study reports the outcome of the lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear. METHODS Included were 33 patients with an average age of 53 years (range, 31-66 years). All patients had symptomatic massive irreparable rotator cuff tear that failed conservative or prior surgical treatment and underwent reconstruction with lower trapezius transfer prolonged by Achilles tendon allograft. The tear was considered irreparable based on the magnetic resonance imaging finding of ≥2 full-thickness rotator cuff tears associated with shortening and retraction of the tendon to the level of the glenoid and a high grade of fatty infiltration of the muscles. This was confirmed at the time of the surgery. RESULTS At an average follow-up of 47 months, 32 patients had significant improvement in pain, subjective shoulder value, and Disabilities of the Arm, Shoulder and Hand score and shoulder range of motion, including flexion, 120°; abduction, 90°; and external rotation 50°. One patient, with a body mass index of 36 kg/m(2), required débridement for an infection and then later underwent shoulder fusion. Patients with >60° of preoperative flexion had more significant gains in their range of motion. Shoulder external rotation improved in all patients regardless of the extent of the preoperative loss of motion. CONCLUSIONS Transfer of the lower trapezius prolonged with Achilles tendon allograft to reconstruct massive irreparable posterior-superior rotator cuff tear may lead to good outcome in most patients, specifically for those who have preoperative flexion of >60°.
Collapse
Affiliation(s)
| | - Eric R Wagner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
8
|
Abstract
Restoration of shoulder function in patients with brachial plexus injury can be challenging. Initial reported efforts were focused on stabilizing the shoulder, improving inferior subluxation and restoring abduction and flexion of the joint. Recent advancements and improved understanding of coordinated shoulder motion and the biomechanical properties of the muscles around the shoulder applicable to tendon transfer have expanded available surgical options to improve shoulder function, specifically external rotation. Despite the advances in reconstructive options, brachial plexus injury remains a serious problem that requires complex surgical solutions, prolonged recovery, and acceptance of functional loss.
Collapse
Affiliation(s)
- Chelsea C Boe
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | - Bassem T Elhassan
- Department of Orthopedic Surgery, College of Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| |
Collapse
|
9
|
Elhassan BT, Wagner ER, Spinner RJ, Bishop AT, Shin AY. Contralateral Trapezius Transfer to Restore Shoulder External Rotation Following Adult Brachial Plexus Injury. J Hand Surg Am 2016; 41:e45-51. [PMID: 26787407 DOI: 10.1016/j.jhsa.2015.12.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the outcome of contralateral lower trapezius origin transfer (CLTOT) to restore shoulder external rotation in patients with shoulder paralysis after brachial plexus injury (BPI). METHODS We evaluated 12 patients with a history of BPI with persistent shoulder paralysis. All patients had compromised ipsilateral lower trapezius muscle function. All patients underwent CLTOT prolonged with lumbar fascia to the affected infraspinatus tendon either isolated (7 patients) or as part of multiple tendon transfer (5 patients). Standardized patient outcomes measures were obtained. RESULTS At 23 months' follow-up, 10 patients had improved shoulder external rotation from no motion preoperatively to an average external rotation 110° from the abdomen. Five patients had marked improvement of pain, including 2 with isolated CLTOT and 3 with additional tendon transfers. Two patients experienced no change in pain. There were noted improvements in the Constant shoulder scores, simple shoulder value, and Disabilities of the Arm, Shoulder, and Hand scores. One patient sustained a fall resulting in stretch injury to the transfer, underwent successful revision surgery, and regained 100° active shoulder external rotation away from the abdomen more than a year after revision surgery. Another patient's transfer failed during rehabilitation but the patient elected not to pursue treatment. No patients had changes in contralateral shoulder motion or strength or any pain from the contralateral shoulder. CONCLUSIONS This study demonstrated that CLTOT to the infraspinatus tendon was effective in improving shoulder external rotation in patients with BPI. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
| | - Eric R Wagner
- Department of Orthopedics, Mayo Clinic, Rochester, MN
| | | | | | | |
Collapse
|
10
|
Satbhai NG, Doi K, Hattori Y, Sakamoto S. Contralateral lower trapezius transfer for restoration of shoulder external rotation in traumatic brachial plexus palsy: a preliminary report and literature review. J Hand Surg Eur Vol 2014; 39:861-7. [PMID: 24212416 DOI: 10.1177/1753193413512245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The importance of external rotation of the shoulder is well accepted. Patients with inadequate recovery of shoulder function after nerve transfers for a brachial plexus injury have difficulty in using their reconstructed limb. The options for secondary procedures to improve shoulder function are often limited, especially if the spinal accessory nerve has been used earlier for nerve transfer or as a donor nerve for a free functioning muscle transfer. We have used the contralateral lower trapezius transfer to the infraspinatus in three cases, to restore shoulder external rotation. All patients had significant improvement in shoulder external rotation (mean 97°; range 80°-110°) and improved disability of the arm, shoulder and hand scores. The rotation occurred mainly at the glenohumeral joint, and was independent of the donor side. All patients were greatly satisfied with the outcome. Contralateral lower trapezius transfer appears to help in overall improvement of shoulder function by stabilizing the scapula. The results have remained stable after mean follow-up of 58 months (range 12-86). No donor site deficit was seen in any patient.
Collapse
Affiliation(s)
- N G Satbhai
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - K Doi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Y Hattori
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - S Sakamoto
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| |
Collapse
|