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Velasquez Garcia A, Nieboer MJ, de Marinis R, Morrey ME, Valenti P, Sanchez-Sotelo J. Mid- to long-term outcomes of latissimus dorsi tendon transfer for massive irreparable posterosuperior rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 2024; 33:959-974. [PMID: 37993088 DOI: 10.1016/j.jse.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/20/2023] [Accepted: 10/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND This study aims to analyze the mid-to long-term results of the latissimus dorsi tendon for the treatment of massive posterosuperior irreparable rotator cuff tears as reported in high-quality publications and to determine its efficacy and safety. METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and EMBASE databases were searched until December 2022 to identify studies with a minimum 4 year follow-up. Clinical and radiographic outcomes, complications, and revision surgery data were collected. The publications included were analyzed quantitatively using the DerSimonian Laird random-effects model to estimate the change in outcomes from the preoperative to the postoperative condition. The proportion of complications and revisions were pooled using the Freeman-Tukey double arcsine transformation. RESULTS Of the 618 publications identified through database search, 11 articles were considered eligible. A total of 421 patients (432 shoulders) were included in this analysis. Their mean age was 59.5 ± 4 years. Of these, 277 patients had mid-term follow-up (4-9 years), and 144 had long-term follow-up (more than 9 years). Postoperative improvements were considered significant for the following outcome parameters: Constant-Murley Score (0-100 scale), with a mean difference (MD) = 28 points (95% confidence interval [CI] 21, 36; I2 = 89%; P < .001); visual analog scale, with a standardized MD = 2.5 (95% CI 1.7, 3.3; P < .001; I2 = 89%; P < .001); forward flexion, with a MD = 43° (95% CI 21°, 65°; I2 = 95% P < .001); abduction, with a MD = 38° (95% CI 20°, 56°; I2 = 85%; P < .01), and external rotation, with a MD = 8° (95% CI 1°, 16°; I2 = 87%; P = .005). The overall reported mean complication rate was 13% (95% CI 9%, 19%; I2 = 0%), while the reported mean revision rate was 6% (95% CI: 3%, 9%; I2 = 0%). CONCLUSIONS Our pooled estimated results seem to indicate that latissimus dorsi tendon transfer significantly improves patient-reported outcomes, pain relief, range of motion, and strength, with modest rates of complications and revision surgery at mid-to long-term follow-up. In well-selected patients, latissimus dorsi tendon transfer may provide favorable outcomes for irreparable posterosuperior cuff tears.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Clinica Universidad de los Andes, Santiago, Chile
| | - Micah J Nieboer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rodrigo de Marinis
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile; Shoulder and Elbow Unit, Hospital Dr. Sótero del Rio, Santiago, Chile
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Mercurio M, Castricini R, Castioni D, Cofano E, Familiari F, Gasparini G, Galasso O. Better functional outcomes and a lower infection rate can be expected after superior capsular reconstruction in comparison with latissimus dorsi tendon transfer for massive, irreparable posterosuperior rotator cuff tears: a systematic review. J Shoulder Elbow Surg 2023; 32:892-906. [PMID: 36528222 DOI: 10.1016/j.jse.2022.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/25/2022] [Accepted: 11/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Massive, irreparable rotator cuff tears, if left untreated, may result in cuff tear arthropathy, which causes shoulder disability and pain. The primary outcome of this systematic review was to evaluate differences in functional outcomes between the arthroscopic superior capsular reconstruction (SCR) and latissimus dorsi tendon transfer (LDTT) for the treatment of massive, irreparable posterosuperior rotator cuff tears without arthritis. The secondary outcome was to compare complication and reoperation rates between the 2 surgical procedures. METHODS The PubMed, MEDLINE, Scopus, and Cochrane Central databases were searched using keywords, and 20 studies were included in this review. Data extracted for quantitative analysis included the American Shoulder and Elbow Surgeons score, the Constant-Murley score, the subjective shoulder value, the range of motion, the visual analog scale for pain, numbers and types of complications, and reoperation rate. The preoperative fatty degeneration of the muscles and the preoperative and follow-up acromiohumeral distance and glenohumeral osteoarthritis according to the Hamada grading system were also reported. RESULTS A total of 1112 patients were identified, among whom 407 and 399 underwent SCR and LDTT, respectively. The SCR group showed a higher mean age at the time of operation (64.5 ± 7.8 vs. 62.1 ± 8.9 years; P < .001). The SCR group showed a lower rate of previous surgical procedures on the shoulder (35 out of 407 vs. 111 out of 399; P < .001) and a shorter mean follow-up (30.4 ± 7.5 vs. 36.3 ± 10.3 months; P < .001). Patients who underwent SCR reported significantly better functionality and residual pain as measured by the Constant-Murley score (75.5 ± 11.2 vs. 65.6 ± 22.8, P < .001), the American Shoulder and Elbow Surgeons score (84.3 ± 13 vs. 67.7 ± 23, P < .001), the subjective shoulder value (79.4 ± 13 vs. 64.4 ± 23, P < .001), and the visual analog scale (1.4 ± 2 vs. 2.8 ± 3, P < .001) than patients who underwent LDTT. A greater acromiohumeral distance (5.8 ± 2.5 vs. 7.6 ± 2.7, P < .001) was found in the SCR group. The SCR group showed a significantly lower infection rate (0.2% vs. 2.8%., P = .003) and a higher graft failure rate (12.3% vs. 6.8%, P = .012). No differences in terms of reoperation for graft failure (1% vs. 2.3% for SCR and LDTT, respectively; P = .172) or for conversion to reverse total shoulder arthroplasty (1.7% vs. 2% for SCR and LDTT, respectively; P = .800) were found. CONCLUSION Patients undergoing SCR report better functional outcomes and greater acromiohumeral distance than those undergoing LDTT. The LDTT group shows a significantly higher infection rate, while the SCR group shows a significantly higher graft failure rate, but there are no differences in terms of reoperation between the 2 surgical procedures.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, "Villa Verde" Hospital, Fermo, Italy; Department of Orthopaedic and Trauma Surgery, "Villa Maria Cecilia" Hospital, Cotignola, Italy
| | - Davide Castioni
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy; Department of Orthopedic and Trauma Surgery, Girolamo Fracastoro Hospital, Verona, Italy
| | - Erminia Cofano
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy.
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
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Checchia CS, da Silva LA, do Val Sella G, Checchia SL, de Moraes Barros Fucs PM, Miyazaki AN. Allograft-enhanced latissimus dorsi transfer is better than the conventional technique for irreparable posterosuperior rotator cuff tears. A retrospective matched cohort. INTERNATIONAL ORTHOPAEDICS 2023; 47:1527-1534. [PMID: 36951977 DOI: 10.1007/s00264-023-05775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Latissimus dorsi tendon (LDT) transfer (LDTT) to the greater tuberosity to treat irreparable posterosuperior rotator cuff tears (RCTs) in young active patients has been shown to have up to 36% of clinical failures, most of them happening because of either deltoid origin disruption or post-operative transfer rupture from the greater tuberosity. In an attempt to simultaneously prevent both complications, a modified technique includes the following adaptations to the original technique: reinforcement and augmentation of the LDT with a tendinous allograft, enabling the use of a single deltopectoral approach. The aim of this study is to compare mid-term outcomes of the traditional LDTT technique with this modified transfer. METHODS Retrospective cohort study comparing two groups who underwent either the traditional (group 1; n = 19) or the modified technique (group 2; n = 27). Group homogenization was assured by statistical comparison of 24 baseline independent variables. The outcome variables were the gains to active shoulder range of motions (ROM) and UCLA scores (and all its subscores, independently), at a minimum follow-up of two years. A p value < .05 was considered to be statistically significant. RESULTS At a mean follow-up of 25 months, both groups have shown improvements to most variables. However, group two (modified technique) achieved greater improvements to UCLA score (p = .009), active external rotation (p = .006) and internal rotation (p = .008). CONCLUSION At mid-term follow-up, improvements to outcomes of the modified (single approach, allograft-enhanced) latissimus dorsi transfer were greater than those of the original technique.
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Affiliation(s)
- Caio Santos Checchia
- Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil.
- Hospital Sírio-Libanês, São Paulo, Brazil.
| | | | | | - Sergio Luiz Checchia
- Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Alberto Naoki Miyazaki
- Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
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Premsiri A, Mahasupachai N, Chanlalit C. Arthroscopic-assisted lower trapezius transfer with peroneus longus graft for massive irreparable rotator cuff tear and glenohumeral joint instability: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:539-545. [PMID: 37588471 PMCID: PMC10426571 DOI: 10.1016/j.xrrt.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Arnakorn Premsiri
- Department of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Nattakorn Mahasupachai
- Department of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Cholawish Chanlalit
- Department of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
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Miyazaki AN, Checchia CS, Fonseca Filho JM, Rosa JRP, Val Sella GD, Silva LAD. Resultados da transferência do grande dorsal alongado com enxerto tendíneo homólogo por via delto-peitoral para lesões póstero-superiores irreparáveis do manguito rotador. Rev Bras Ortop 2022; 57:590-598. [PMID: 35966441 PMCID: PMC9365491 DOI: 10.1055/s-0041-1724073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/02/2020] [Indexed: 11/15/2022] Open
Abstract
Objective
The primary aim of the present study is to evaluate the functional results of a modification to the latissimus dorsi (LD) transfer around the shoulder for irreparable posterosuperior rotator cuff tears. The secondary aim is to evaluate variables that might influence the outcomes.
Surgical Technique
Through a single deltopectoral approach, the LD tendon is detached, reinforced, and elongated with a tendinous allograft, transferred around the humerus, and fixed superolaterally to the greater tuberosity and anteriorly to the subscapularis.
Methods
Retrospective functional evaluation of 16 cases. The average follow-up was 21 months (12–47). The postoperative results (at last follow-up) were compared with the preoperative ones, as well as to other pre, intra, and postoperative variables.
Results
All (but one) patients were satisfied. Average University of California, Los Angeles (UCLA) score increased from 11.6 (8–16) to 27.3 (17–30) (
p
< 0.001). Improvements of shoulder pain, function, and strength achieved statistical significance (
p
< 0.001). Nonetheless, normal strength was never restored. Average active range of motion improved as follows: forward elevation, from 106° (60–140°) to 145° (130–160°) (
p
< 0.001); external rotation from 30° (0° to 60°) to 54° (40–70°) (
p
< 0.001); and internal rotation from L1 (gluteus to T7) to T10 (T12–T3) (
p
< 0.05). No complication has occurred. Preoperative pseudoparesis was reverted in all the six cases in which it was present. None of the variables analyzed influenced the outcomes, including pseudoparesis.
Conclusions
At early follow-up, this technique is safe and effective at recovering from pseudoparesis and at improving shoulder pain, function, and strength.
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Affiliation(s)
- Alberto Naoki Miyazaki
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Caio Santos Checchia
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - João Manoel Fonseca Filho
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
- Departamento de Cirurgia Ortopédica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - João Roberto Polydoro Rosa
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
- Departamento de Cirurgia Ortopédica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - Guilherme do Val Sella
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Luciana Andrade da Silva
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
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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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Okutan AE, Gül O. Pseudoparalysis and Acromiohumeral Interval Reversibility Are the Most Important Factors Affecting the Achievement of Patient-Acceptable Symptom State After Arthroscopic-Assisted Latissimus Dorsi Tendon Transfer. Arthroscopy 2022; 38:1824-1830. [PMID: 34915140 DOI: 10.1016/j.arthro.2021.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the patient-acceptable symptom state (PASS) values for American Shoulder and Elbow Surgeons (ASES) score and the Constant-Murley (CM) score after arthroscopic-assisted latissimus dorsi tendon transfer (LDTT) and to identify potential factors affecting the achievement of PASS. METHODS Fifty consecutive patients who underwent arthroscopic-assisted LDTT between 2015 and 2020 were retrospectively analyzed. In total, 42 patients met the inclusion criteria with minimum follow-up of 1 year postoperative. Patients were evaluated preoperatively and 1-year postoperatively with multiple clinical measurements including ASES, CM, score and PASS. The primary outcome was identified as patient satisfaction which assessed with achievement of a PASS. Potential factors affecting the patient satisfaction including age, sex, body mass index, previous surgery, presence of pseudoparalysis, critical shoulder angle, shoulder abduction moment index, acromiohumeral interval (AHI) reversibility, Hamada grade and fatty infiltration were evaluated for their association with PASS value by stepwise logistic regression analysis. RESULTS A total of 42 patients were evaluated with mean follow-up 27.8 ± 8.21 months. The ASES and CM scores improved from preoperative means of 21.6 ± 6.5 and 25.2 ± 8.5 to 65.6 ± 20.7 points and 56.8 ± 16.5 points, respectively (P < .001). The PASS values for the ASES and CM scores were 62.4 and 52.5, respectively. The univariate analysis showed that older age (P = .021), presence of pseudoparalysis (P < .001), previous surgery (P = .016), lower preoperative AHI (P = .028), and lower AHI reversibility (P < .001) were all significantly associated with worse patient satisfaction. The multivariable logistic regression analysis showed that pseudoparalysis (P = .038) and AHI reversibility (P = .021) were independent prognostic factors affecting the achievement of a PASS after arthroscopic-assisted LDTT. The cutoff value for AHI reversibility to predict an achievement of PASS was found to be 4.0 mm. CONCLUSIONS Arthroscopic-assisted LDTT led to satisfactory results in patients with massive rotator cuff tears. However, pseudoparalysis and AHI reversibility were the most important independent prognostic factors that consistently reduced and increased, respectively, the odds of achieving a PASS. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ahmet Emin Okutan
- Orthopaedic and Traumatology Dept., Karadeniz Technical University, School of Medicine, Trabzon, Turkey.
| | - Orkun Gül
- Orthopaedic and Traumatology Dept., Karadeniz Technical University, School of Medicine, Trabzon, Turkey
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Abstract
Massive rotator cuff tears (MRCTs) present a particular challenge due to high rates of retear that can range from 18 to 94%, failure of healing after repair, and potential for irreparability. Management of MRCTs must take into consideration the patient's characteristics, clinical examamination and expectation, number and quality of muscle tendons units involved. Conservative treatment, arthroscopic long head of the biceps tenotomy, cuff debridement, partial repair, and superior capsule reconstruction are viable solutions to treat selected patients. The goal of tendon transfers is to achieve stable kinematic by restoring rotational strength and force coupling of the shoulder joint. The ideal candidate is a young, motivated patient with small degenerative changes of the glenohumeral joint, a massive irreparable cuff tear, significant atrophy, fatty infiltration, and functional deficit. Patients with posterosuperior massive tears have impaired shoulder function with external rotation weakness and eventually lag sign If the teres minor is affected. Latissimus dorsi transfer is the most used with results lasting for long follow-up and lower Trapezius transfer is becoming a surgical option. For anterosuperior tears, there is still controversial if pectoralis major is the best option when compared to latissimus dorsi although this last has a similar vector force with the supraspinatus tendon. Complications associated with tendon transfers include neurovascular injury, infection, and rupture of the transferred tendon.
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Affiliation(s)
- Antonio Cartucho
- Shoulder and Elbow Unit, Hospital Cuf Descobertas, Lisbon, Portugal
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Checchia CS, Silva LAD, Sella GDV, Fregoneze M, Miyazaki AN. Current Options in Tendon Transfers for Irreparable Posterosuperior Rotator Cuff Tears. Rev Bras Ortop 2021; 56:281-290. [PMID: 34239191 PMCID: PMC8249074 DOI: 10.1055/s-0040-1709988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/10/2020] [Indexed: 10/28/2022] Open
Abstract
Massive irreparable posterosuperior rotator-cuff tears are debilitating lesions that usually require surgical treatment. Even though there is no consensus regarding the best surgical technique, tendinous transfers around the shoulder are the most commonly performed procedures. The latissimus dorsi tendon remains the most commonly used, but different modifications to the original technique have been shown to minimize complications and to improve functional results and satisfaction. Other techniques, such as the transfer of the lower trapezius tendon, are promising and should be considered, especially for patients with isolated loss of external rotation. The present paper is a literary review regarding tendon transfers for irreparable posterosuperior rotator-cuff tears.
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Affiliation(s)
- Caio Santos Checchia
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Luciana Andrade da Silva
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Guilherme do Val Sella
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Marcelo Fregoneze
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Alberto Naoki Miyazaki
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
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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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Florczynski M, Paul R, Leroux T, Baltzer H. Prevention and Treatment of Nerve Injuries in Shoulder Arthroplasty. J Bone Joint Surg Am 2021; 103:935-946. [PMID: 33877057 DOI: 10.2106/jbjs.20.01716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Nerve injuries during shoulder arthroplasty have traditionally been considered rare events, but recent electrodiagnostic studies have shown that intraoperative nerve trauma is relatively common. ➤ The brachial plexus and axillary and suprascapular nerves are the most commonly injured neurologic structures, with the radial and musculocutaneous nerves being less common sites of injury. ➤ Specific measures taken during the surgical approach, component implantation, and revision surgery may help to prevent direct nerve injury. Intraoperative positioning maneuvers and arm lengthening warrant consideration to minimize indirect injuries. ➤ Suspected nerve injuries should be investigated with electromyography preferably at 6 weeks and no later than 3 months postoperatively, allowing for primary reconstruction within 3 to 6 months of injury when indicated. Primary reconstructive options include neurolysis, direct nerve repair, nerve grafting, and nerve transfers. ➤ Secondary reconstruction is preferred for injuries presenting >12 months after surgery. Secondary reconstructive options with favorable outcomes include tendon transfers and free functioning muscle transfers.
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Affiliation(s)
- Matthew Florczynski
- Departments of Orthopaedic Surgery (M.F., R.P., and T.L.) and Plastic and Reconstructive Surgery (R.P. and H.B.), University of Toronto, Toronto, Ontario, Canada
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Clouette J, Leroux T, Shanmugaraj A, Khan M, Gohal C, Veillette C, Henry P, Paul RA. The lower trapezius transfer: a systematic review of biomechanical data, techniques, and clinical outcomes. J Shoulder Elbow Surg 2020; 29:1505-1512. [PMID: 32169465 DOI: 10.1016/j.jse.2019.12.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/29/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lower trapezius (LT) transfers were originally described to restore external rotation (ER) in the management of brachial plexus palsy; however, there is recent interest in the role of this transfer to restore shoulder function, specifically ER, in patients with a massive irreparable rotator cuff tear (RCT). The purpose of this systematic review is to summarize the current literature pertaining to LT transfers, including biomechanics, techniques, and clinical outcomes for patients with brachial plexus palsy and massive RCTs. METHODS MEDLINE, EMBASE, and PubMed were searched for biomechanical and clinical studies, as well as technique articles. Four biomechanical studies reported on moment arms, range of motion (ROM), and force vectors. Seven clinical studies reported postoperative ROM and functional outcomes, and weighted mean improvements in ROM were calculated. RESULTS Overall, 18 studies were included, and then subdivided into 3 themes: biomechanical, technique, and clinical. Biomechanical studies comparing LT and latissimus dorsi (LD) transfers observed an overall larger moment arm in abduction and ER in adduction for the LT transfer, with similar results in forward elevation. Clinical studies noted significant improvement in shoulder function following the LT transfer, including ROM and functional outcome scores. There were several described techniques for performing the LT transfer, including arthroscopically assisted and open approaches, and the use of both allograft and autograft augmentation. CONCLUSION This study suggests that the LT transfer is generally safe, and the clinical and biomechanical data to date support the use of the LT transfer for restoration of function in these challenging patient populations.
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Affiliation(s)
- Julien Clouette
- The Arthritis Program, University Health Network, Toronto, ON, Canada
| | - Timothy Leroux
- The Arthritis Program, University Health Network, Toronto, ON, Canada.
| | | | - Moin Khan
- Department of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Chetan Gohal
- Department of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Patrick Henry
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ryan A Paul
- The Arthritis Program, University Health Network, Toronto, ON, Canada
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Combined Fully Arthroscopic Transfer of Latissimus Dorsi and Teres Major for Treatment of Irreparable Posterosuperior Rotator Cuff Tears. Arthrosc Tech 2019; 9:e147-e157. [PMID: 32021789 PMCID: PMC6993265 DOI: 10.1016/j.eats.2019.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/12/2019] [Indexed: 02/03/2023] Open
Abstract
Many treatment options have been proposed for treatment of irreparable posterosuperior rotator cuff tears. Among these options, latissimus dorsi tendon transfer can be considered a good alternative, especially in young patients before development of glenohumeral arthritic changes, aiming at rebalancing the shoulder with a functioning subscapularis muscle and restoring both active external rotation and elevation with the aid of a properly functioning deltoid muscle. The technique was recently adapted from open to arthroscopically assisted with numerous advantages. We propose a combined fully arthroscopic technique for transfer of latissimus dorsi and teres major in which the tendons are fixed in a flat manner at the junction of supraspinatus and infraspinatus to decrease failure rate.
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