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Warren ES, Hurley ET, Bethell MA, Loeffler BJ, Hamid N, Klifto CS, Anakwenze O. Tendon Transfers in Reverse Total Shoulder Arthroplasty: A Systematic Review. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202408000-00008. [PMID: 39137406 PMCID: PMC11321750 DOI: 10.5435/jaaosglobal-d-24-00174] [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: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE The purpose of this study was to evaluate clinical outcomes after tendon transfers in the setting of reverse total shoulder arthroplasty (RTSA). METHODS PubMed and Embase were searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to find primary clinical studies of any type of tendon transfer in the setting of RTSA. RESULTS Overall, 17 studies (level of evidence [LOE] I: 1, LOE II: 0, LOE III: 3, LOE IV: 13) met inclusion criteria, with 300 shoulders. Most patients were female (56.7%), with an average age of 68.7 years (range 19 to 89) and a mean follow-up of 46.2 months (range 6 to 174). 11 studies reported outcomes after combined latissimus dorsi and teres major transfer (LDTM) while eight studies reported on latissimus dorsi transfer only (LD). Improvements in commonly reported subjective and functional outcome measures were as follows: external rotation +32° (LDTM) and +30° (LD), flexion +65° (LDTM) and +59° (LD), Visual Analog Score -5.4 (LDTM) and -4.5 (LD), subjective shoulder value +43.8% (LDTM) and +46.3% (LD), and overall Constant score +33.8 (LDTM) and +38.7 (LD). The overall complication rate was 11.3%, including tendon transfer ruptures (0.7%), instability (3.0%), infection (2.0%), and nerve injury (0.3%). The all-cause repeat operation rate was 7.3%, most commonly for arthroplasty revision (5.3%). Subgroup analysis revealed that lateralized implants with tendon transfer resulted in markedly greater improvements in Constant score, flexion, ER1, and ER2 while medialized implants with tendon transfer had markedly greater improvements in Visual Analog Score, subjective shoulder value, and abduction. CONCLUSION Patients undergoing tendon transfer of either combined LDTM or latissimus dorsi alone in the setting of RTSA have markedly improved subjective and functional outcomes. A moderate incidence of complications (11.3%) was noted in this patient population.
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Affiliation(s)
- Eric S. Warren
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
| | - Eoghan T. Hurley
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
| | - Mikhail A. Bethell
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
| | - Bryan J. Loeffler
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
| | - Nady Hamid
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
| | - Christopher S. Klifto
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
| | - Oke Anakwenze
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
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Tan AKS, Chung IDW, Lee WQ, Lie DTT. Latissimus dorsi and teres major transfer in reverse shoulder arthroplasty: A systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:379-384. [PMID: 39157216 PMCID: PMC11329039 DOI: 10.1016/j.xrrt.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Background This paper aims to conduct a systematic review of the current literature to evaluate the clinical outcomes of concurrent latissimus dorsi and teres major (LD/TM) tendon transfer in reverse shoulder arthroplasty (RSA), and to compare that to isolated RSA. Methods A comprehensive search on PubMeb, Web of Science, Embase and CINAHL was performed from inception up to January 20, 2023, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Cohort studies, case-control studies, randomized controlled trials and case series that were written in English, which involved patients who underwent RSA with LD/TM transfer were included. Quality of studies was appraised using the Cochrane Risk Of Bias In Nonrandomized Studies of Interventions tool. Systematic review of Constant-Murley Score (CMS) and range of movement (ROM) was conducted. Results Eight studies with a total of 265 patients were included. The average mean follow-up time was 42.5 months, with a range of 6 months to 136 months. Of the studies that reported outcomes of RSA with LD/TM transfer, five reported the CMS, five reported external rotation (ER) ROM and six reported forward flexion ROM. Comparing postoperative to preoperative scores, there was an improvement above the minimal clinically important difference for CMS (mean difference (MD) range = 22.40 to 41.80), ER (MD range = 29° to 36°) and forward flexion (MD range = 50° to 75°). Three studies that compared postoperative ER between RSA with and without LD/TM reported no significant difference. Conclusion RSA with LD/TM transfer has good clinical outcomes postoperatively, but there is insufficient comparative data to suggest that it is superior or inferior to an isolated RSA.
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Affiliation(s)
- Ashton Kai Shun Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Isaac De Wei Chung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Wen Qiang Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Hones KM, Rakauskas TR, Wright JO, King JJ, Wright TW, Werthel JD, Schoch BS, Hao KA. Outcomes of Reverse Total Shoulder Arthroplasty with Latissimus Dorsi Tendon Transfer for External Rotation Deficit: A Systematic Review and Meta-Analysis. JBJS Rev 2023; 11:01874474-202306000-00016. [PMID: 37339240 DOI: 10.2106/jbjs.rvw.23.00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
BACKGROUND Latissimus dorsi transfer (LDT) has been purported to restore motion in patients undergoing reverse shoulder arthroplasty (RSA) who have preoperative combined loss of forward elevation (FE) and external rotation (ER). This systematic review summarizes the available evidence for the functional outcomes and complications after RSA with LDT. Furthermore, the effect of implant design and whether a concomitant teres major transfer (TMT) was performed were studied. METHODS A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting on LDT with RSA to restore ER. Our primary outcomes were ER, FE, Constant score, and complication incidence. Secondarily, we reported postoperative internal rotation (IR) and compared ER, FE, and Constant score based on lateralized versus medialized global implant design and whether concomitant TMT was performed. RESULTS Nineteen studies were evaluated; functional outcomes were assessed in 16 articles reporting on 258 RSAs (123 LDT, 135 LDT-TMT). Surgical indication was most commonly cuff tear arthropathy and massive irreparable cuff tear. Mean ER was -12° preoperatively and 25° postoperatively, FE was 72° preoperatively and 141° postoperatively. Mean postoperative Constant score was 65. Of 138 patients (8 studies) describing IR, only 25% reported a mean postoperative IR ≥L3. Subanalysis comparing lateralized versus medialized implants and whether TMT was concomitantly performed demonstrated no significant difference in postoperative ER, FE, and Constant score, nor preoperative to postoperative improvement in ER and FE. The complication rate was 14.1% (of 291 shoulders from 16 studies), including tear in the tendon transfer (n = 3), revision tendon repair (n = 1), nerve-related complication (n = 9), and dislocation (n = 9). CONCLUSIONS RSA with LDT is a reliable option to restore motion, with a comparable complication rate with standard RSA. The use of medialized versus lateralized implants and whether the TM was concomitantly transferred may not influence clinical outcomes. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Keegan M Hones
- College of Medicine, University of Florida, Gainesville, Florida
| | | | - Jonathan O Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Joseph J King
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Thomas W Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Jean-David Werthel
- Department of Orthopedic Surgery, Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, Florida
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Kazum E, Martinez-Catalan N, Caruso G, Schofield BA, Nidtahar I, Zampeli F, Valenti P. Reverse shoulder arthroplasty with isolated latissimus dorsi or combined with teres major transfer for lack of external rotation: a comparative study. INTERNATIONAL ORTHOPAEDICS 2022; 46:2273-2281. [PMID: 35922519 DOI: 10.1007/s00264-022-05530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The objective of this study was to evaluate the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) associated with two techniques: L'Episcopo procedure (combined teres major and latissimus dorsi transfer) and modified L'Episcopo procedure (isolated latissimus dorsi transfer). METHODS A retrospective review of 36 RSAs (mean age 69.8 years; SD 8.9) associated with either L'Episcopo procedure (Group 1, 21 cases) or modified L'Episcopo procedure (Group 2, 15 cases) was performed between 2007 and 2020. Clinical outcome measures consisted of range of motion (ROM), SSV, VAS, and Constant-Murley scores. These scores were compared between the two groups. Radiographs were assessed for transfer site bony lesions. RESULTS With a mean follow-up of 40.8 months (6-98; SD 28.8), no significant differences were revealed in the clinical outcomes: Constant score, SSV, VAS, ROM. The entire study group demonstrated a significant improvement in post-operative functional outcome scores and ROM parameters compared to their pre-operative state, IR measures being the only exception (p = 0.26). Radiographs demonstrated transfer site bony lesions in 60% of the patients (18/30). Three complications (8.3%) were noted in the study. CONCLUSION At the short-term follow-up, RSA combined with either latissimus dorsi (LD) transfer in isolation or in association with teres major proved to be equally effective in restoring external rotation in the settings of an irreparable postero-superior cuff tear treated with RSA. Although the LD transfer group displayed a tendency towards superior ROM, this was not supported statistically. Post-operative radiographs confirmed the presence of bony lesions at the transfer fixation sites in both groups of patients (52% vs. 72%).
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Affiliation(s)
- Efi Kazum
- Tel Aviv Sourasky Medical Center, Division of Orthopaedic Surgery, Affiliated to Sackler Faculty of Medicine Tel Aviv University, Weizmann St 6, 6423906, Tel Aviv, Israel.
| | | | - Giovanni Caruso
- Shoulder Unit, Koelliker Hospital, Corso Galileo Ferraris, 247/255, 10134, Turin, Italy
| | | | - Imen Nidtahar
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France
| | - Frantzeska Zampeli
- Hand-Upper Limb-Microsurgery Department, General Hospital KAT, Athens, Greece
| | - Philippe Valenti
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France
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Editorial Commentary: Predictors of Best Outcomes After Latissimus Dorsi Transfer for Irreparable Rotator Cuff Tear. Arthroscopy 2022; 38:1831-1833. [PMID: 35660179 DOI: 10.1016/j.arthro.2022.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 02/02/2023]
Abstract
The management of patients with massive posterosuperior rotator cuff tears without glenohumeral arthritis remains a challenge to arthroscopic surgeons. A wide variety of treatment options have been described, including latissimus dorsi tendon transfer (LDTT) and lower trapezius tendon transfer. These tendon transfers have been utilized to rebalance the glenohumeral force couple for patients with massive or irreparable posterosuperior rotator cuff tears. Proponents of the latissimus dorsi tendon transfer have touted several theoretical advantages, including improvement of the shoulder fulcrum, optimization of the deltoid function, improved humeral head depression, and restoration of shoulder motion. Currently accepted contra-indications to LDTT include glenohumeral arthritis, irreparable subscapularis tear, axillary nerve palsy and/or deltoid insufficiency. However, few studies have investigated the ideal patient selection for LDTT, particularly as it relates to clinically significant outcomes. Recent literature suggests a high rate of complications and re-tear following LDTT, and studies suggest that older age, previous surgery, true pseuoparalysis, lower low pre-operative acromiohumeral interval (AHI) or AHI reversibility negatively impact results. Ultimately, candidates for tendon transfer should be carefully stratified according to their modifiable and non-modifiable risk factors, and surgeons should understand how pre-operative patient characteristics may affect the treatment options available for this unique patient population. In the setting of supraspinatus and infraspinatus deficiency, we prefer to utilize the lower trapezius tendon transfer, given its more predictable handling characteristics, ease of harvest, and greater function consistency compared to LDTT.
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Valenti P, Zampeli F, Caruso G, Nidtahar I, Martinez-Catalan N, Kazum E. Proximal humeral bone defect in reverse shoulder arthroplasty combined with latissimus-dorsi transfer is not related with a poor outcome. Orthop Traumatol Surg Res 2022; 108:103263. [PMID: 35248792 DOI: 10.1016/j.otsr.2022.103263] [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: 07/27/2021] [Revised: 12/18/2021] [Accepted: 01/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RSA) associated with modified L'Episcopo (isolated LD) or L'Episcopo (combined TM and LD) procedures had been confirmed to effectively overcome the expected external rotation deficit in patient with postero-superior massive cuff tear and teres minor deficiency. The objective of this study was to evaluate the radiological bony lesions of the lateral proximal humerus following RSA combined with tendon transfer, and to determine whether these bony lesions affect the clinical outcome. MATERIAL AND METHODS A retrospective review of 24 RSAs (mean age 68.71 years, range 52-83) associated with modified L'Episcopo procedure (9) and L'Episcopo procedure (15) was performed. X-rays were assessed for lateral cortex lesions and were categorized into either intact, irregular or complete lytic appearances. In addition, signs of stem loosening were assessed. Clinical outcome measures included range of motion, SSV, VAS, and Constant-Murley scores. RESULTS With a mean follow-up of 44.71 months (12-97; SD 27.42), eight (33.3%) patients demonstrated intact lateral cortex, eight (33.3%) irregular and eight (33.3%) lytic lesions. 40% of cemented stems demonstrated a deformed cortex compared to 74% of cementless stems. Radiolucent lines were detected in one cemented stem (p=0.046). GT resorption (p=0.147), condensations lines (p=0.449) and spot weld (p=0.342), appeared exclusively in non-cemented stem. Postoperatively all patients (24) demonstrated significant improvements in all clinical and functional parameters. A comparison between patient with (Group 2, 16 patients) and without bony lesions (Group 1, 8 patients) revealed no significant differences in functional scores and range of motion: Constant (p=0,61), VAS (p=0,61), SSV (p=0,66) and external rotation (p=0,34). CONCLUSION At short-term follow-up, RSA combined with L'Episcopo or modified l'Episcopo procedure resulted in high incidence (67%) of lateral proximal humerus lesions. Radiolucent lines were noted in cemented stems whereas, signs of stress shielding and GT resorption appeared in non-cemented stems. Yet, no case of humeral loosening was detected and these lesions did not seem to affect the clinical outcome. The use of cemented straight standard-length humeral stems should be positively considered in RSA associated with LD\TM tendon transfer. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Philippe Valenti
- Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France
| | - Frantzeska Zampeli
- Hand-Upper Limb-Microsurgery Department, General Hospital KAT, Athens, Greece
| | - Giovanni Caruso
- Shoulder Unit, Koelliker Hospital, Corso Galileo Ferraris 247/255, 10134 Turin, Italy
| | - Imen Nidtahar
- Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France
| | - Natalia Martinez-Catalan
- Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France; Hospital Fundación Jiménez Diaz, Madrid, Spain
| | - Efi Kazum
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Weizmann St 6, 6423906, Tel Aviv, Israel.
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Marigi EM, Harstad C, Elhassan B, Sanchez-Sotelo J, Wieser K, Kriechling P. Reverse shoulder arthroplasty after failed tendon transfer for irreparable posterosuperior rotator cuff tears. J Shoulder Elbow Surg 2022; 31:763-771. [PMID: 34592412 DOI: 10.1016/j.jse.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tendon transfers (TTs) can be successful for the management of selected posterosuperior functionally irreparable rotator cuff tears. However, when these procedures fail to provide adequate pain relief or functional improvement, reverse shoulder arthroplasty (RSA) is commonly considered the next treatment option. The effect of prior TT on RSA remains largely unknown. The purposes of this investigation were to evaluate the outcomes of RSA after previous TT performed for posterosuperior functionally irreparable rotator cuff tears and to determine the effect of various TT types on RSA. METHODS A retrospective review of 2 institutional databases identified 33 patients who underwent RSA implantation between 2006 and 2019 with a previous failed tendon transfer (FTT) of the shoulder and at least 2 years of clinical follow-up. FTTs included 21 latissimus dorsi transfers, 6 latissimus dorsi and teres major (LD-TM) transfers, and 6 lower trapezius transfers. RSAs were performed at an average of 5.5 years (range, 0.3-28 years) after FTT, with a mean follow-up period of 4.1 ± 2.0 years. Outcomes evaluated included the visual analog scale pain score, range of motion, absolute Constant-Murley score (CS) and relative CS, American Shoulder and Elbow Surgeons score, Subjective Shoulder Value, complications, and implant survivorship free of reoperation or revision. RESULTS RSA significantly improved pain and function, with improvements in the visual analog scale pain score (6.2 preoperatively vs. 2.2 at most recent follow-up, P < .001), active elevation (85° vs. 111°, P < .001), American Shoulder and Elbow Surgeons score (51 vs. 74, P = .001), absolute CS (34 vs. 48, P = .003), and relative CS (42% vs. 59%, P = .002), exceeding the minimal clinically important difference threshold. There were 7 complications (21%) across the entire cohort, with dislocation (n = 3, 9.1%) as the most common complication. Comparison across TT groups showed that LD-TM transfer had the highest complication rate (3 shoulders, 50%), followed by lower trapezius transfer (1 shoulder, 16.7%); latissimus dorsi transfer had the lowest rate (3 shoulders, 14.3%; P = .037). Survivorship free of revision or reoperation was estimated to be 90.1% at 1 year, 84.9% at 2 years, and 71.2% at 5 years, with no difference among TT groups (P = .654). CONCLUSIONS RSA can serve as a viable salvage option for FTT procedures. At mid-term follow-up, RSA led to significant improvements in pain, range of motion, and patient-reported outcomes. Patients with prior LD-TM transfers may have a higher complication rate, but no other differences were found between TT groups.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Chelsea Harstad
- Department of Orthopedic Surgery, Mass General Hospital, Boston, MA, USA
| | - Bassem Elhassan
- Department of Orthopedic Surgery, Mass General Hospital, Boston, MA, USA
| | | | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Philipp Kriechling
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
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Alonso-Rodriguez Piedra J, Souza Virgolino B, Gamez Baños F, Miranda Elstein Q, Ventura Parellada C, Mora Guix JM. Reverse total shoulder arthroplasty with latissimus dorsi and teres major transfer: biomechanical and electromyographical outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1003-1012. [PMID: 35278134 DOI: 10.1007/s00590-022-03238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE There is controversy regarding the optimal treatment for patients with rotator cuff arthropathy with external rotation deficit (CLEER group). This study analyzes the biomechanical and electromyographical outcomes of reverse total shoulder arthroplasty (RTSA) with latissimus dorsi and teres major transfer. The primary objective of this study is to compare the biomechanical and electromyographical outcomes between the treated and contralateral shoulder. Secondary objective is to define clinical and functional outcomes, and to report the radiological findings. Our hypothesis is that with this technique patients regain at least 50% of the strength in external rotation of the contralateral shoulder, and that the transferred muscles remain EMG active over time. MATERIALS AND METHODS All patients who underwent RTSA with latissimus dorsi and teres major transfer in our hospital between 2007 and 2015 were included. From 16 eligible patients, 10 were finally reviewed. Biomechanical assessment of rotation strength was performed postoperatively in both shoulders, and fine needle EMG of latissimus dorsi and teres major muscles was recorded at the same time in both shoulders. Constant test and clinical evaluation (Lag sign and Hornblower test) were obtained preoperative and at final follow up. Radiological (X-ray, US) assessment was also obtained for both shoulders at final follow up. RESULTS External rotation strength of the operated shoulder was higher than 50% the strength of the contralateral shoulder, and the differences were statistically significant (p < 0.05). No statistically differences were found regarding to internal rotation. The electromyographic assessment found no significant differences (p > 0.05) between the treated and contralateral shoulders. The mean Constant-Murley score significantly increased (30.9 points) after surgery (p < 0.01). Lag sign and Hornblower test were negative in all patients. CONCLUSIONS Performing RTSA with latissimus dorsi and teres major transfer is an effective procedure improve function and to restore ER strength in patients in CLEER group. The EMG records shows that transposed latissimus dorsi and teres major adapt to their new function and remain functional over time, even in elderly patients.
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Affiliation(s)
| | | | - Ferran Gamez Baños
- Orthopaedic Service. Hospital de Terrassa, Ctra Torrebonica S/N, 08227, Terrassa, Spain
| | | | | | - Jose M Mora Guix
- Orthopaedic Service. Hospital de Terrassa, Ctra Torrebonica S/N, 08227, Terrassa, Spain
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Suroto H, De Vega B, Deapsari F, Prajasari T, Wibowo PA, Samijo SK. Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:941-955. [PMID: 34760293 PMCID: PMC8559569 DOI: 10.1302/2058-5241.6.210049] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Despite rapid medical technology development, various challenges exist in three- and four-part proximal humeral fracture (PHF) management. This condition has led to a notably increased use of the reverse total shoulder arthroplasty (RTSA); however, open reduction and internal fixation (ORIF) is still the most widely performed procedure. Thus, these two modalities are crucial and require further discussion. We aim to compare the outcomes of three- or four-part PHF surgeries using ORIF and RTSA based on direct/head-to-head comparative studies.We conducted a systematic review and meta-analysis based on the Cochrane handbook and PRISMA guidelines. We searched MEDLINE (PubMed), Embase (Ovid), and CENTRAL (Cochrane Library) from inception to October 2020. Our protocol was registered at PROSPERO (registration number CRD42020214681). We assessed the individual study risk of bias using ROB 2 and ROBINS-I tools, then appraised our evidence using the GRADE approach.Six head-to-head comparative studies were included, comprising one RCT and five retrospective case-control studies. We found that RTSA significantly improved forward flexion but was comparable to ORIF in abduction (p = 0.03 and p = 0.47, respectively) and more inferior in external rotation (p < 0.0001). Moreover, RTSA improved the overall Constant-Murley score, but the difference was not significant (p = 0.22). Interestingly, RTSA increased complications (by 42%) but reduced the revision surgery rates (by 63%) compared to ORIF (p = 0.04 and p = 0.02, respectively).RTSA is recommended to treat patients aged 65 years or older with a three- or four-part PHF. Compared to ORIF, RTSA resulted in better forward flexion and Constant-Murley score, equal abduction, less external rotation, increased complications but fewer revision surgeries. Cite this article: EFORT Open Rev 2021;6:941-955. DOI: 10.1302/2058-5241.6.210049.
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Affiliation(s)
- Heri Suroto
- Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia
- These authors contributed equally to this work
| | - Brigita De Vega
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Cell & Tissue Bank-Regenerative Medicine Centre, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
- These authors contributed equally to this work
| | - Fani Deapsari
- Cell & Tissue Bank-Regenerative Medicine Centre, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Tabita Prajasari
- Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia
| | - Pramono Ari Wibowo
- Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia
| | - Steven K. Samijo
- Department of Orthopaedics and Traumatology Zuyderland Medisch Centrum, Heerlen, the Netherlands
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Reverse Total Shoulder Arthroplasty with Concurrent Latissimus Dorsi Tendon Transfer. Curr Rev Musculoskelet Med 2021; 14:297-303. [PMID: 34581990 DOI: 10.1007/s12178-021-09715-6] [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: 09/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Reverse total shoulder arthroplasty (rTSA) has emerged as an effective treatment option for patients with rotator cuff arthropathy resulting from irreparable rotator cuff tears. However, patients with combined loss of abduction and external rotation may still experience functional deficits after rTSA. One option to address this has been the latissimus dorsi tendon transfer (LDTT), or modified L'Episcopo procedure. The purpose of this review is to describe the role of LDTT with rTSA and to critically evaluate the evidence on whether a supplemental LDTT ultimately improves patient function. RECENT FINDINGS Patients with an intact rotator cuff demonstrated a significant increase in active external rotation following rTSA compared to those with a deficient rotator cuff following rTSA. Compared to their pre-operative baseline assessments, patients who undergo rTSA with LDTT report significant improvements in active external rotation. However, a randomized trial comparing rTSA patients with and without LDTT failed to demonstrate a significant difference in active external rotation or patient-reported outcomes between groups. Observational studies have shown that patients experience significant improvements in active range of motion and various patient-reported outcome measures following rTSA with latissimus dorsi tendon transfer. When directly comparing rTSA with LDTT to rTSA alone, the current literature fails to demonstrate a statistically significant difference in active external rotation or patient-reported outcomes at short-term follow-up. Further randomized controlled trials are required to fully understand the potential benefits of added tendon transfer in the rTSA patient population.
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Merolla G, Cuoghi F, Athwal GS, Parel I, Filippi MV, Cutti AG, Fabbri E, Padolino A, Paladini P, Catani F, Porcellini G. A kinematic and electromyographic comparison of a Grammont-style reverse arthroplasty combined with a l'Episcopo transfer compared to a lateralized humeral component reverse for restoration of active external rotation. INTERNATIONAL ORTHOPAEDICS 2021; 45:2061-2069. [PMID: 34212229 DOI: 10.1007/s00264-021-05122-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess kinematic and electromyographic findings of two designs of reverse total shoulder arthroplasty (RTSA). We tested two hypotheses: (H1) Grammont-style (RTSA) with l'Episcopo tendon transfer gains similar postoperative kinematic findings of a lateralized humeral component RTSA without a tendon transfer; (H2) RTSA with lateralized humeral component induces earlier shoulder muscle activation during shoulder motion compared with standard Grammont prosthesis with l'Episcopo transfer. METHODS Twenty-five patients with a cuff tear arthropathy, pseudoparalysis, and a positive dropping sign were sequentially included. A Grammont-style RTSA with a l'Episcopo tendon transfer was implanted in 13 patients (medialized humerus and transfer group) and an on-lay curved-stem RTSA in 12 (lateralized humerus group). Constant score; the disabilities of the arm, shoulder, and hand (DASH) score; and active shoulder range of motion (flexion, abduction, external rotation, and internal rotation) were measured pre- and postoperatively. Upper limb kinematic and surface electromyography (EMG) (anterior and posterior deltoid; upper, middle, and lower trapezius; and the upper and lower latissimus dorsi muscles) were recorded during active range of motion. RESULTS At > 24 months of follow-up, the Constant and DASH scores and active shoulder range of motion improved in both groups (p < 0.0001). Internal rotation was significantly higher in the lateralized humerus group than in the medialized humerus and transfer group (p = 0.004). The dropping sign was found in 0/12 patients in the lateralized humerus group and in 5/13 patients in the medialized humerus and transfer group (p < 0.001). Kinematic findings were similar between groups (p = 0.286). A pattern of earlier muscle activation in the lateralized humerus group was found as compared to the transfer group as follows: (i) posterior deltoid during external rotation (p = 0.004); (ii) upper latissimus dorsi and middle and lower trapezius during flexion (p = 0.004, p = 0.005, and p = 0.042, respectively); (iii) lower latissimus dorsi during abduction (p = 0.016). CONCLUSION RTSA with a lateralized humeral component provided similar active external rotation restoration to a Grammont-style RTSA with a l'Episcopo procedure in patients with a dropping sign. The posterior deltoid muscle underwent earlier activation during active external rotation in the lateralized humerus RTSA group as compared to the tendon transfer group. Our findings demonstrated the H1 and only partially demonstrated the H2 of the study.
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Affiliation(s)
- Giovanni Merolla
- Shoulder and Elbow Unit, Cervesi Hospital, Cattolica - AUSL Romagna, Via L. v. Beethoven 5, Code: 47841, Cattolica, Italy.
- Biomechanics Laboratory, Cervesi Hospital, Cattolica - AUSL Romagna, Cattolica, Italy.
- International Doctorate School (PhD) in Clinical and Experimental Medicine, Modena, Italy.
| | - Francesco Cuoghi
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Modena, Italy
| | - George S Athwal
- St Joseph's Hospital, Roth McFarlane Hand & Upper Limb Center, London, ON, Canada
| | - Ilaria Parel
- Biomechanics Laboratory, Cervesi Hospital, Cattolica - AUSL Romagna, Cattolica, Italy
| | - Maria V Filippi
- Functional Recovery and Rehabilitation Unit - AUSL Romagna, Forlì, Italy
| | | | | | - Antonio Padolino
- Shoulder and Elbow Unit, Cervesi Hospital, Cattolica - AUSL Romagna, Via L. v. Beethoven 5, Code: 47841, Cattolica, Italy
| | - Paolo Paladini
- Shoulder and Elbow Unit, Cervesi Hospital, Cattolica - AUSL Romagna, Via L. v. Beethoven 5, Code: 47841, Cattolica, Italy
| | - Fabio Catani
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Porcellini
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Modena, Italy
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Kleim BD, Siebenlist S, Scheiderer B, Imhoff AB. [Irreparable rotator cuff tear-reverse shoulder arthroplasty and alternative procedures]. Unfallchirurg 2021; 124:117-124. [PMID: 33245367 DOI: 10.1007/s00113-020-00922-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Irreparable rotator cuff tears represent a significant everyday clinical challenge. A high degree of tendon retraction and muscle degeneration means that a direct reconstruction is impossible. Patients often suffer from pain and pseudoparalysis. In older patients this can reliably be resolved by the implantation of a semiconstrained inverse shoulder prosthesis; however, for younger patients joint-preserving techniques should be employed. Furthermore, for frail older patients who may not be suitable for a joint replacement operation, alternative treatment strategies are required. Management options include physiotherapy and pain relieving or reconstructive operations. Minimally invasive arthroscopic treatment approaches can lead to pain relief and slight functional improvements in selected patients; however, to restore the active movement of the joint a partial cuff repair, augmentation with a graft or replacement with muscle transfer is necessary. This article presents the various treatment options and the results reported in the literature. Through this a treatment algorithm is suggested in order to facilitate management decisions.
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Affiliation(s)
- B D Kleim
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - S Siebenlist
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - B Scheiderer
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - A B Imhoff
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Valenti P, Zanjani LO, Schoch BS, Kazum E, Werthel JD. Mid- to long-term outcomes after reverse shoulder arthroplasty with latissimus dorsi and teres major transfer for irreparable posterosuperior rotator cuff tears. INTERNATIONAL ORTHOPAEDICS 2021; 45:1263-1271. [PMID: 33517474 DOI: 10.1007/s00264-021-04948-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
AIM The objective of this study was to describe the outcome of reverse shoulder arthroplasty (RSA) combined with modified L'Episcopo procedure at long-term follow-up (5 to 12 years). METHODS A retrospective review of 17 RSAs (mean age 67.2 years) with the modified L'Episcopo procedure conducted between 2006 and 2016 was performed. All patients had a combined loss of active elevation and external rotation with an irreparable posterosuperior rotator cuff tear. Clinical assessment was performed with a minimum follow-up of five years (mean 97.3 months). Outcome measures included range of motion, subjective shoulder value (SSV), visual analogue scale (VAS), and Constant-Murley scores. RESULTS All patients (16) demonstrated a significant improvement in all clinical and functional parameters. VAS pain scores improved from 6 ± 2.6 to 1 ± 1; SSV improved from 35 ± 14 to 72 ± 10; active forward elevation increased from 66° ± 34 to 125° ± 29; and active external rotation arm at the body increased from -11° ± 22 to 21° ±11 and in 90° of abduction from -10° ± 17 to 37° ± 24. The mean Constant score improved from 25 ± 11 to 59 ± 8. Active internal rotation did not significantly change (p = 0.332). CONCLUSION At long-term follow-up, RSA combined with modified L'Episcopo procedure resulted in significant improvements in pain, range of motion, and functional scores for patients with shoulder pseudoparalysis and a lack of active external rotation caused by a massive posterosuperior cuff tear with a teres minor deficiency.
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Affiliation(s)
- Philippe Valenti
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France
| | - Leila Oryadi Zanjani
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France.,Shariati Hospital, District 6, Tehran, Tehran Province, 1313514117, Iran
| | | | - Efi Kazum
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France. .,Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center, Weizmann St 6, 6423906, Tel Aviv, Israel.
| | - Jean David Werthel
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France.,Hopital Ambroise Pare, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
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Chirkov NN, Nikolaev NS, Kaminskii AV, Spiridonova OV. Reverse Shoulder Arthroplasty with <i>Latissimus Dorsi</i> Transfer for Humerus Fractures Sequelae. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2020; 26:25-33. [DOI: https:/doi.org/10.21823/2311-2905-2020-26-3-25-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Relevance. Fractures of the proximal humerus occupy the 3rd place in the structure of fractures in the elderly. Failure to treat these injuries leads to irreversible changes in the shoulder. The main treatment for the latter is arthroplasty. The surgical treatment of this category of patients is still a difficult task. The purpose of this study was to compare the effectiveness of standard reverse arthroplasty with reverse arthroplasty in combination with the reconstruction of the external rotators of the shoulder or transposition of the latissimus dorsi. Materials and Methods. The retrospective evaluation of treatment results of 96 patients with consequences of shoulder injuries was conducted. Of these, 51 patients underwent standard reverse arthroplasty (group I), and 45 patients (group II) underwent arthroplasty with reconstruction of the external rotators of the shoulder or transposition of the latissimus dorsi. The female patients accounted for 68.8%. The duration of the injury varied from 8 months to 2.5 years, the follow-up — from 1 to 7 years (Me = 3.5). The results were assessed with VAS, ASES, UCLA scales. Results. The positive outcomes were observed in most patients. Complications: dislocations of the endoprosthesis occurred in 16.7%, infectious complications — in 5.2%, shoulder component instability — in 2.1%, fracture of the humeral diaphysis — in 3.1%, neurovascular bundle injury — in 2.1% of cases. In the patients of group I, dislocations occurred significantly more often than in the patients of group II. To reduce the risk of complications, a rational tactic has been developed for treating patients with consequences of shoulder injuries. If electroneuromyography values from the deltoid muscle were less than 40% of the contralateral side, or if mineral bone density T-score was less than 2.5 SD, arthroplasty was not performed. During arthroplasty, it is necessary to perform the direct suturing of the of the infraspinatus and teres minor tendons to the humerus. If it is impossible, the latissimus dorsi transfer is indicated. Conclusion. Reverse arthroplasty in the treatment of the humerus fractures sequelae is an effective technique. To reduce the risk of complications, it is necessary to provide the additional stability of the endoprosthesis by reconstruction of the external rotators or latissimus dorsi transfer. It is advisable to refrain from arthroplasty in cases of severe deltoid hypotrophy and severe osteoporosis.
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Parsons M, Routman HD, Roche CP, Friedman RJ. Preoperative external rotation deficit does not predict poor outcomes or lack of improvement after reverse total shoulder arthroplasty. J Orthop 2020; 21:379-383. [PMID: 32921945 DOI: 10.1016/j.jor.2020.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/19/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The purpose was to compare postoperative outcomes and functional improvement between patients with preoperative aER deficits vs. preserved aER function. RESULTS There were 115 patients in the <0° aER group and 314 in the ≥30° aER group. Preoperative patients in the <0° group were worse for all measures except subjective pain while post-operatively, they had significantly greater improvement for all measures of motion. Postoperatively, both groups achieved comparable scores for forward elevation, pain, SST and ASES. CONCLUSION This study demonstrates that patients with a complete aER deficit can recover substantial and comparable function after RTSA.
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Affiliation(s)
- Moby Parsons
- The Knee, Hip and Shoulder Center, Portsmouth, NH, USA
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Thon SG, Seidl AJ, Bravman JT, McCarty EC, Savoie FH, Frank RM. Advances and Update on Reverse Total Shoulder Arthroplasty. Curr Rev Musculoskelet Med 2019; 13:11-19. [PMID: 31884675 DOI: 10.1007/s12178-019-09582-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Reverse total shoulder arthroplasty (RTSA) is a procedure that has been increasingly utilized since its inception over 20 years ago. The purpose of this review is to present the most up to date practice and advances to the RTSA literature from the last 5 years. RECENT FINDINGS Recent literature on RTSA has focused on identifying complications, maximizing outcomes, and determining its cost-effectiveness. RTSA has become a valuable tool in the treatment of various shoulder pathologies from fractures to massive-irreparable rotator cuff tears. Maximizing outcomes, proper patient counseling, and limiting complications are vital to a successful procedure. RTSA can be a difficult procedure; however, when utilized appropriately, it can be an invaluable tool in the orthopedic surgeon's armament. Recent evidence suggests, more and more, that RTSA not only provides value to the patient, but it is also cost-effective.
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Affiliation(s)
- Stephen G Thon
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Adam J Seidl
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan T Bravman
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eric C McCarty
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Felix H Savoie
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
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Popescu IA, Bihel T, Henderson D, Martin Becerra J, Agneskirchner J, Lafosse L. Functional improvements in active elevation, external rotation, and internal rotation after reverse total shoulder arthroplasty with isolated latissimus dorsi transfer: surgical technique and midterm follow-up. J Shoulder Elbow Surg 2019; 28:2356-2363. [PMID: 31300368 DOI: 10.1016/j.jse.2019.04.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 04/07/2019] [Accepted: 04/15/2019] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS This study investigated the hypothesis that reverse total shoulder arthroplasty (RSA) in combination with an isolated latissimus dorsi tendon (LDT) transfer in patients with pseudoparalysis of abduction and external rotation (combined loss of active elevation and external rotation [CLEER] syndrome) would demonstrate improved postoperative functional results. METHODS This study was a retrospective single-surgeon case series of 13 consecutive patients with CLEER who underwent RSA without subscapularis repair and combined with an isolated LDT transfer. We reviewed 10 patients (77%), at a minimum of 2 years, with 3 cases lost to follow-up. Shoulder function was assessed preoperatively and postoperatively using the Constant score and postoperatively using the Oxford Shoulder Score, University of California-Los Angeles score, American Shoulder and Elbow Surgeons score, ADLEIR (activities of daily living [ADLs] requiring active external and internal rotation) score, and ADLIR (ADLs requiring active internal rotation) score. Force in internal rotation (IR) at 0° of abduction, external rotation (ER) at 0° of abduction, and ER at 90° of abduction, as well as IR in the belly-press position, was measured. RESULTS The mean postoperative follow-up period was 57 months (range, 31-85 months). We observed improvement in the Constant score (from 29.8 ± 6.64 preoperatively to 71.9 ± 10.45 postoperatively, P < .05), as well as abduction force, ER, and forward elevation (P < .05). Postoperatively, the mean American Shoulder and Elbow Surgeons score was 95.1 ± 3.38 and the mean Oxford Shoulder Score was 46.6 ± 1.57. Mean force in IR at 0° of abduction was 5.45 ± 2.42 kg, and mean force in ER at 90° of abduction was 4 ± 1.20 kg. Mean force in ER at 0° of abduction (3.65 ± 1.24 kg) and IR in the belly-press position (4.5 ± 2.84 kg) demonstrated a positive correlation with ADLs. CONCLUSIONS The results of this study demonstrate that RSA without subscapularis repair, combined with an isolated LDT transfer, provides improved postoperative functional outcomes for patients with CLEER while maintaining sufficiently balanced force in IR and ER to effectively perform ADLs.
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Affiliation(s)
- Ion-Andrei Popescu
- Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France; go:h Gelenkchirurgie Orthopädie Hannover, Hannover, Germany; Hannover Medical School, Hannover, Germany.
| | - Thomas Bihel
- Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France
| | - Daniel Henderson
- Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France
| | | | - Jens Agneskirchner
- go:h Gelenkchirurgie Orthopädie Hannover, Hannover, Germany; Hannover Medical School, Hannover, Germany
| | - Laurent Lafosse
- Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France
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