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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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La Banca V, Bonadiman JA, Gonzalez FF, Gustafson JA, Leporace G, Garrigues GE, Chahla J, Metsavaht L. Changes in in vivo three dimensional shoulder kinematics following latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears: A systematic review with meta-analysis. Clin Biomech (Bristol, Avon) 2024; 111:106148. [PMID: 37979245 DOI: 10.1016/j.clinbiomech.2023.106148] [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: 07/19/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Latissimus dorsi transfer is a surgical procedure that can be used for treating posterosuperior rotator cuff tears. The procedure leads to improved shoulder function via alterations in the force vector couple around the shoulder. However, there is still no consensus on the biomechanical changes resulting from latissimus dorsi transfer. METHODS We performed a systematic review of the literature on 3D motion analysis studies evaluating the effects of latissimus dorsi transfer on shoulder kinematics. The available data on segment and joint range of motion was extracted and subject to meta-analysis when consistent across the studies. FINDINGS Our meta-analysis of pre- and post-operative studies revealed a significant improvement in forward flexion and abduction following latissimus dorsi transfer. When comparing the latissimus transferred shoulder with an uninjured contralateral side the meta-analysis found no significant difference in flexion range of motion, while abduction and external rotation was significantly higher in the uninjured shoulders. The overall risk of bias was moderate to high. High heterogeneity was found in the reporting of data, which limited our ability to perform a meta-analysis across the studies for all interest outcomes. INTERPRETATIONS Our findings suggest that latissimus dorsi transfer for posterosuperior rotator cuff tears effectively improves shoulder flexion and abduction. External rotation is also expected to improve but at inferior levels as compared to the unaffected side. However, the heterogeneity of the reported data on 3D motion analysis studies highlights the need for better standardization in research and reporting as to conclude the impact of different joints.
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Affiliation(s)
- Vitor La Banca
- Midwest Orthopedics at Rush, Rush University Medical Center, 1611 West Harrison St, Chicago, IL, USA; Instituto Brasil de Tecnologia da Saúde, R.Visc de Pirajá, 407, Rio de Janeiro, RJ, Brazil; Disciplina de Ortopedia, Centro Universitário Faculdade de Medicina do ABC (FMABC), Av. Lauro Gomes, 2000, Santo André, SP, Brazil.
| | - João Artur Bonadiman
- Midwest Orthopedics at Rush, Rush University Medical Center, 1611 West Harrison St, Chicago, IL, USA; Instituto Brasil de Tecnologia da Saúde, R.Visc de Pirajá, 407, Rio de Janeiro, RJ, Brazil.
| | - Felipe Fernandes Gonzalez
- Midwest Orthopedics at Rush, Rush University Medical Center, 1611 West Harrison St, Chicago, IL, USA; Instituto Brasil de Tecnologia da Saúde, R.Visc de Pirajá, 407, Rio de Janeiro, RJ, Brazil.
| | - Jonathan Adam Gustafson
- Midwest Orthopedics at Rush, Rush University Medical Center, 1611 West Harrison St, Chicago, IL, USA; Instituto Brasil de Tecnologia da Saúde, R.Visc de Pirajá, 407, Rio de Janeiro, RJ, Brazil.
| | - Gustavo Leporace
- Instituto Brasil de Tecnologia da Saúde, R.Visc de Pirajá, 407, Rio de Janeiro, RJ, Brazil; Depto. de Diagnóstico por Imagem - Escola Paulista de Medicina, Universidade Federal de São Paulo, R. Napoleão de Barros, 800, São Paulo, SP, Brazil.
| | - Grant E Garrigues
- Midwest Orthopedics at Rush, Rush University Medical Center, 1611 West Harrison St, Chicago, IL, USA.
| | - Jorge Chahla
- Midwest Orthopedics at Rush, Rush University Medical Center, 1611 West Harrison St, Chicago, IL, USA.
| | - Leonardo Metsavaht
- Instituto Brasil de Tecnologia da Saúde, R.Visc de Pirajá, 407, Rio de Janeiro, RJ, Brazil.
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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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Celli A, Paroni C, Bonucci P, Celli L. Long-term outcomes of teres major transfer for irreparable posterosuperior rotator cuff tears in patients aged <65 years. JSES Int 2022; 7:35-43. [PMID: 36820419 PMCID: PMC9937853 DOI: 10.1016/j.jseint.2022.08.020] [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] [Indexed: 10/14/2022] Open
Abstract
Background Massive rotator cuff tears are defined as irreparable when tendon-to-bone or tendon-to-tendon continuity with the adducted arm cannot be restored and severe muscle fatty infiltration is present. Tendon transfer is a palliative procedure that improves shoulder function and relieves pain. Methods We reviewed the records of patients aged <65 years, whose irreparable posterosuperior rotator cuff tears had been managed with teres major tendon transfer at our institution. Their 5- and 10-year clinical and radiographic follow-up records were examined to assess long-term outcomes. Patients' Constant Score, Disabilities of the Arm, Shoulder, and Hand score, and the visual analog scale for pain were calculated before the procedure and at 5 and 10 years. Results There were 24 consecutive patients aged <65 years (mean, 59; 12 men and 12 women) who had received no prior treatment except rehabilitation. All patients underwent teres major tendon transfer due to the failure of conservative treatment. The mean Constant Score was 26 preoperatively and 68 and 66 at 5 and 10 years, respectively (P = .0001 and P = .25). The mean Disabilities of the Arm, Shoulder, and Hand scores were 62.2 preoperatively and 7.8 and 9.3 at 5 and 10 years, respectively (P = .0009 and P = .1). The mean visual analog scale scores at rest were 6.1 preoperatively, and 0.3 and 0.5 at 5 and 10 years, respectively (P = .0003 and P = .1). Based on Hamada's classification, at 5 years, 3 patients showed grade 2 changes, and another had grade 3 changes; at 10 years, 7 patients showed grade 2 changes, and one showed grade 3 changes. Complications (8%) developed after the 10-year evaluation and included pain in 1 patient and secondary rupture of the transfer in another. Discussion Improving shoulder function and reducing pain in relatively young patients with irreparable posterosuperior cuff tears involves replacing the lost muscle with a muscle-tendon transfer. The chief aims of the procedure are to restore the balance with the subscapularis muscle, achieve joint stability, keep the humeral head in the glenoid cavity, and improve shoulder abduction and external rotation. Teres major tendon transfer can achieve these goals. Altogether, 22 of our 24 patients experienced improved daily activity function and pain relief that became stable after 5 years. Teres major transfers are useful surgical procedures, particularly in younger patients and in those with high functional demands, providing good and stable long-term results.
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Affiliation(s)
- Andrea Celli
- Corresponding author: Andrea Celli, MD, Via Emilia Est 380∖1 Modena 41124, Italy.
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Hughes JD, Davis B, Whicker E, Sprowls GR, Barrera L, Baradaran A, Sabzevari S, Burnham JM, Shah AA, Lin A. Nonarthroplasty options for massive, irreparable rotator cuff tears have improvement in range of motion and patient-reported outcomes at short-term follow-up: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 31:1883-1902. [PMID: 35972518 DOI: 10.1007/s00167-022-07099-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare various nonarthroplasty treatment options for massive, irreparable rotator cuff tears, including allograft bridging/augmentation, debridement, partial repair, superior capsule reconstruction (SCR), subacromial balloon spacer, and tendon transfer. METHODS A comprehensive search was conducted through the PubMed, MEDLINE, and EMBASE databases for all articles pertaining to nonarthroplasty treatment options for irreparable rotator cuff tears. Inclusion criteria included manuscripts published between 2009 and 2020 with at least 1 year follow-up and Level I-IV evidence. Articles were separated into six groups: debridement, arthroscopic and open repair, allograft bridging/augmentation, SCR, subacromial balloon spacer, and tendon transfer. Data points included range of motion (external rotation, abduction, forward flexion, and internal rotation), visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Constant score, rate of revision surgery, and rate of conversion to arthroplasty. RESULTS A total of 83 studies and 3363 patients were included. All treatment options had statistically significant improvements in postoperative range of motion and patient-reported outcomes. Debridement had statistically significantly greater postoperative abduction and forward flexion range of motion, as well as better VAS pain scores, compared to the other treatment options. The SCR subgroup had the greatest improvement in ASES scores postoperatively. The overall revision rate was 7.2% among all surgical options, with the allograft bridging/augmentation group having the lowest rate of revision at 0-8.3%. The overall rate of conversion to arthroplasty was 7.2%, with debridement having the greatest rate of conversion at 15.4%. CONCLUSION All six nonarthroplasty treatment options for irreparable rotator cuff tears resulted in statistically significant improvements in range of motion and patient-reported outcomes at 1 year follow-up or more, with low rates of revision and conversion to arthroplasty. Debridement had statistically significantly greater postoperative abduction and forward flexion range of motion, as well as better VAS pain scores, compared to the other treatment options. However, these conclusions should be interpreted with caution due to the heterogeneous nature of the data, lack of prospective randomized control trials, and short-term follow-up. The findings of this study highlight the complexity of irreparable, massive rotator cuff tears, and the need for an individualized approach when treating these patients. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jonathan D Hughes
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.
| | - Brian Davis
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Emily Whicker
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Gregory R Sprowls
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center-Temple, Temple, TX, USA
| | - Lindsay Barrera
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Ashkan Baradaran
- Department of Orthopaedic Surgery, Mashhad University of Medical Sciences, Mashhad, Khorasan Razavi, Iran
| | - Soheil Sabzevari
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.,Department of Orthopaedic Surgery, Mashhad University of Medical Sciences, Mashhad, Khorasan Razavi, Iran
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, Ochsner Health System Baton Rouge, Baton Rouge, LA, USA
| | - Anup A Shah
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Orthopaedic Surgery, Kelsey-Seybold Clinic, Houston, TX, USA
| | - Albert Lin
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
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Gurnani N, van Deurzen DFP, Willems WJ, Janssen TWJ, Veeger DHEJ. Shoulder muscle activity after latissimus dorsi transfer in active elevation. JSES Int 2022; 6:970-977. [DOI: 10.1016/j.jseint.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gurnani N, Willems WJ, van Deurzen DFP, Weening AA, Bouwer J, Janssen TWJ, Veeger DHEJ. Shoulder kinematics and muscle activity following latissimus dorsi transfer for massive irreparable posterosuperior rotator cuff tears in shoulders with pseudoparalysis. J Shoulder Elbow Surg 2022; 31:1357-1367. [PMID: 35172211 DOI: 10.1016/j.jse.2022.01.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the thoracohumeral (TH) and glenohumeral (GH) motion with muscle activity after latissimus dorsi transfer (LDT) in a shoulder with a massive irreparable posterosuperior rotator cuff tear (MIRT) and pseudoparalysis compared with the asymptomatic contralateral shoulder (ACS). METHODS We recruited and evaluated 13 patients after LDT in a shoulder with preoperative clinical pseudoparalysis and an MIRT on magnetic resonance imaging, with a minimum follow-up period of 1 year, and with a Hamada stage of 3 or less. Three-dimensional electromagnetic tracking was used to assess shoulder active range of motion in both the LDT shoulder and the ACS. The maximal active elevation of the shoulder (MAES) was assessed and consisted of forward flexion, scapular abduction, and abduction in the coronal plane. Maximal active internal rotation and external rotation were assessed separately. Surface electromyography (EMG) was performed to track activation of the latissimus dorsi (LD) and deltoid muscles during shoulder motion. EMG was scaled to its maximal isometric voluntary contraction recorded in specified strength tests. RESULTS In MAES, TH motion of the LDT shoulder was not significantly different from that of the ACS (F1,12 = 1.174, P = .300) but the GH contribution was significantly lower in the LDT shoulder for all motions (F1,12 = 11.230, P = .006). External rotation was significantly greater in the ACS (26° ± 10° in LDT shoulder vs. 42° ± 11° in ACS, P < .001). The LD percentage EMG maximum showed no significant difference between the LDT shoulder and ACS during MAES (F1,11 = 0.005, P = .946). During maximal active external rotation of the shoulder, the LDT shoulder showed a higher percentage EMG maximum than the ACS (3.0% ± 2.9% for LDT shoulder vs. 1.2% ± 2.0% for ACS, P = .006). CONCLUSIONS TH motion improved after LDT in an MIRT with pseudoparalysis and was not different from the ACS except for external rotation. However, GH motion was significantly lower after LDT than in the ACS in active-elevation range of motion. The LD was active after LDT but not more than in the ACS except for active external rotation, which we did not consider relevant as the activity did not rise above 3% EMG maximum. The favorable clinical results of LDT do not seem to be related to a change in LD activation and might be explained by its effect in preventing proximal migration of the humeral head in active elevation.
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Affiliation(s)
- Navin Gurnani
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands.
| | - W Jaap Willems
- Department of Orthopaedic Surgery, DC Expert Centre, Amsterdam, the Netherlands
| | | | - Alexander A Weening
- Department of Orthopaedic Surgery, Diakonesse Hospital, Utrecht, the Netherlands
| | - Joran Bouwer
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Thomas W J Janssen
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - DirkJan H E J Veeger
- Faculty of Behavioural and Movement Sciences, Delft University of Technology, Delft, the Netherlands
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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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The latissimus dorsi tendon functions as an external rotator after arthroscopic-assisted transfer for massive irreparable posterosuperior rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2020; 28:2367-2376. [PMID: 31811355 DOI: 10.1007/s00167-019-05819-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/27/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Latissimus dorsi tendon transfer is a surgical option for the treatment of massive irreparable posterosuperior rotator cuff tear. Whether a favourable clinical outcome is due to the latissimus dorsi muscle contraction rather than the passive tenodesis effect remains to be confirmed. The purpose of the current case-control study was to evaluate the shoulder kinematics and latissimus dorsi activation after latissimus dorsi tendon transfer. METHODS Eighteen patients suffering from irreparable rotator cuff tear that underwent latissimus dorsi tendon transfer and 18 healthy individuals were examined using a 3D kinematic tracking system and electromyography. Active maximal flexion-extension and abduction-adduction of the humerus were measured for the operated and the contralateral shoulder of the patients and the shoulder of healthy individuals to evaluate the range of motion (ROM) and scapulohumeral rhythm. Electromyographic comparison of isometric contraction between the latissimus dorsi of the operated and contralateral shoulder was carried out. RESULTS After arthroscopic-assisted latissimus dorsi tendon transfer, patients showed comparable flexion and abduction ROM to their asymptomatic contralateral shoulders and to the shoulders of healthy individuals. Significantly higher scapular ROM values were found between the latissimus dorsi tendon transfer side and the shoulders of healthy individuals. While performing external rotation with 0° shoulder abduction, a greater percentage of the electromyographic peak value (p = 0.047) and a higher latissimus dorsi internal/external rotation ratio (p = 0.004) were noted for the transferred muscle in comparison to the contralateral shoulder. CONCLUSION Although the arthroscopic-assisted latissimus dorsi tendon transfer failed to normalize scapulothoracic joint movements of patients, a functional latissimus flap and a shoulder ROM similar to the contralateral side or the shoulder of healthy individuals can be expected after this procedure in patients with massive irreparable posterosuperior rotator cuff tear. LEVEL OF EVIDENCE III.
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Motion quality in rotator cuff tear using an inertial measurement unit: new parameters for dynamic motion assessment. J Shoulder Elbow Surg 2020; 29:593-599. [PMID: 31601462 DOI: 10.1016/j.jse.2019.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/17/2019] [Accepted: 07/28/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE This study aimed to (1) figure out the difference in motion smoothness between a nonpathologic shoulder and the other with a rotator cuff tear by measuring the angular velocity using an inertial measurement unit (IMU) sensor and (2) propose the parameters to describe the difference because there is no literature on this topic. MATERIAL AND METHODS We enrolled patients with rotator cuff disease diagnosed by magnetic resonance imaging. The intact shoulder of participants was compared with the shoulder with rotator cuff tear by using IMU on the basis of the parameters that establish motion smoothness: the number of peaks, the peak velocity-to-mean velocity ratio (PV/MV), and the number of sign reversals. In addition, subgroup analysis was performed with respect to tear size (small to medium vs. large to massive). In addition, correlations with the American Shoulder and Elbow Surgeons score and symptom duration (months) were evaluated. RESULTS Among 24 patients (15 males, 9 females), all 3 parameters for the motion quality of patients with a rotator cuff tear exhibited significant difference. The parameters showed a significant difference between the small to medium tear group and the large to massive tear group. A negative correlation was found between symptom duration and parameters of motion quality, except for PV/MV. CONCLUSIONS Motion quality assessment using IMU showed a marked difference in the shoulder with a rotator cuff tear compared with the intact shoulder. Hence, IMU-based parameters for dynamic motion quality could be considered as an option for assessing the function of the shoulder.
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Ebert-Fillmer S, Bloos UT, El Masri S, Stangl R. [Transfer of latissimus dorsi muscle for irreparable posterosuperior rotator cuff defects in older patients : Medium term results]. Unfallchirurg 2019; 122:544-554. [PMID: 30382285 DOI: 10.1007/s00113-018-0557-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Is transfer of the latissimus dorsi muscle (LDT) a good option in older patients with irreparable posterosuperior rotator cuff tears? MATERIAL AND METHOD In 2010-2016 a total of 25 patients without glenohumeral arthritis and non-reconstructable supraspinatus and infraspinatus tendons, a recentered glenohumeral joint with remaining function in anteversion and irreparable posterosuperior rotator cuff defects were treated using LDT at the Rummelsberg Hospital. Of the patients 9 (36%) had in the past 1 or more attempts at reconstruction of the rotator cuff. All other patients (64%) underwent a primary reconstruction using LDT. The patients had an average age of 61 years and average follow up of 32 months. Of the 25 patients 24 (96%) were clinically followed up with the constant score (CS) and the visual analogue scale (VAS). The operation was performed in the technique described by Gerber to raise the latissimus dorsi but in the beach-chair position. Follow-up treatment was performed for 6 weeks using the ACRO-Assist splint (shoulder brace) in 90 ° abduction with daily limited external rotation exercises, followed by a regular regular rehabilitation on an outpatient basis. RESULTS The average operating time was 112 min (68-199 min). Postoperatively the only complication was an tightly sutured drainage. The preoperative Constantpoint averaged 25 (2-59). The postoperative Constantpoint was 60. The average gain of improvement was 35 points. The age-corrected relative CS was 74 after surgery. Pain perception improved significantly from preoperatively severe to very severe pain to postoperatively minor to no pain. In the VAS score there was a reduction from preoperatively 6 to postoperatively 3 VAS points. The external rotation improved from average 3 points in the CS to 6 points in the CS. The preoperative Constantpoint in patients <60 years (n = 12) was 20, the postoperative 51. The gain was 31 Constantpoints. In patients ≥60 years (n = 12), the preoperative Constantpoint was 31, the postoperative 60. The gain was 29 points. The difference between the age groups was not significant. Previously operatively treated patients (arthroscopic or mini-open reconstruction) all showed an improvement in Constantpoints (26 vs. 32 in primarily non-reconstructed patients); however, on a lower level (45 points in previously operated patients vs. 69 CS points). CONCLUSION With appropriate patient selection, a high gain in CS can be achieved even in older patients using latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears. The VAS score and external rotation significantly improved. Previously attempts in rotator cuff reconstruction demonstrated a negative influence on the clinical outcome.
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Affiliation(s)
- S Ebert-Fillmer
- Klinik für Unfall‑, Schulter- und Wiederherstellungschirurgie, Sportmedizin und Sporttraumatologie, Sana Krankenhaus Rummelsberg, Rummelsberg 71, 90592, Schwarzenbruck, Deutschland.
| | - U T Bloos
- Klinik für Unfall‑, Schulter- und Wiederherstellungschirurgie, Sportmedizin und Sporttraumatologie, Sana Krankenhaus Rummelsberg, Rummelsberg 71, 90592, Schwarzenbruck, Deutschland
| | - S El Masri
- Klinik für Unfall‑, Schulter- und Wiederherstellungschirurgie, Sportmedizin und Sporttraumatologie, Sana Krankenhaus Rummelsberg, Rummelsberg 71, 90592, Schwarzenbruck, Deutschland
| | - R Stangl
- Klinik für Unfall‑, Schulter- und Wiederherstellungschirurgie, Sportmedizin und Sporttraumatologie, Sana Krankenhaus Rummelsberg, Rummelsberg 71, 90592, Schwarzenbruck, Deutschland
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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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Anatomic study of pedicled bipolar teres major transfer for irreparable posterosuperior rotator cuff tears. J Shoulder Elbow Surg 2018; 27:1740-1747. [PMID: 29941305 DOI: 10.1016/j.jse.2018.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 04/15/2018] [Accepted: 04/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of rotator cuff (RC) tears has not included bipolar muscle-tendon transfers to date. The objective of this study was to verify the feasibility of pedicled bipolar teres major (TM) transfer over and under the long head of the triceps brachii (LHT) and compare its versatility with monopolar transfer in a model of supraspinatus (SS) tears in cadavers. METHODS In 6 shoulders of cryopreserved cadavers, we re-created complete SS tears, conducting monopolar and bipolar TM transfers over and under LHT. We compared the morphology of the SS and TM, defect coverage, angle between the transferred TM and major SS axis, and axillary nerve overlap with each technique. RESULTS The TM and SS were morphologically similar. Defect coverage was significantly lower with monopolar transfer (12 ± 4 mm) than with bipolar transfer (39 ± 9 mm under the LHT, P = .003, and 38 ± 8 mm over the LHT, P = .004). The bipolar transfer course over the LHT was the nearest to the SS axis (39° ± 11°, P = .005). We found a greater axillary nerve overlap with bipolar transfer under the LHT (27 ± 8 mm) than with bipolar transfer over the LHT (1 ± 2 mm, P = .005) or monopolar transfer (0 mm, P < .001). CONCLUSION Bipolar TM transfer is possible without neurovascular pedicle interference, obtaining greater RC defect coverage and the closest path to the SS axis when conducted over the LHT compared with monopolar or bipolar transfer under the LHT. Accordingly, it can be considered an alternative option for the treatment of posterosuperior RC defects.
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The contribution of the scapula to active shoulder motion and self-assessed function in three hundred and fifty two patients prior to elective shoulder surgery. INTERNATIONAL ORTHOPAEDICS 2018; 42:2645-2651. [DOI: 10.1007/s00264-018-4027-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/07/2018] [Indexed: 12/20/2022]
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