We describe 14 patients who underwent transfer of latissimus dorsi using a new technique through a single-incision. Their mean age was 61 years (47 to 76) and the mean follow-up was 32 months (19 to 42).The mean Constant score improved from 46.5 to 74.6 points. The mean active flexion increased from 119˚ to 170˚, mean abduction from 118˚ to 169˚ and mean external rotation from 19˚ to 33˚. The Hornblower sign remained positive in three patients (23%) as did the external rotation lag sign also in three patients (23%). No patient had a positive drop-arm sign at follow-up. No significant difference was noted between the mean pre-and postoperative acromiohumeral distance as seen on radiographs. An increased grade of osteoarthritis was found in three patients (23%). Electromyographic analysis showed activity of the transferred muscle in all patients.
Patients with posterosuperior cuff tears lose functional external rotation of the shoulder. Latissimus dorsi and teres major transfer is performed to restore external rotation. Twenty patients with a mean age was 55.8 ± 6 years underwent this procedure and were examined at averages of 24.7 (n = 17) and 70.6 (n = 13) months. Two patients did not improve presumably because of failure of the transfer. The Constant and Murley score increased from 55.6 to 90.4 after 2 years and to 87.9 after 5 years. The mean active flexion increased from 119.4°to 169.3°and reached 170°after 5 years, and mean external rotation increased from 12°to 35°, finally reaching 23°.
Considering the correct indication for latissimus dorsi transfer there is no difference for reduction of pain and active ROM between primary and revision surgery. But the revision cases show a significantly lower age- and gender-matched Constant Score and a higher incidence of a positive Hornblower sign. A higher risk of postoperative complications for the revision group could not be found. In summary, the latissimus dorsi transfer was of significant benefit for both groups and we can also recommend this technique for revision surgery.
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