Arthroscopic-assisted Latissimus Dorsi Tendon Transfer for the Management of Irreparable Rotator Cuff Tears in Middle-aged Physically Active Patients

Abstract

Background: Latissimus dorsi (LD) tendon transfer is used as a treatment option for massive irreparable posterosuperior rotator cuff tears, and recently, an arthroscopic-assisted technique was introduced. This study was undertaken to evaluate the clinical and radiological outcomes of arthroscopic-assisted LD tendon transfer for the management of irreparable rotator cuff tears in active middle-aged patients.Methods: The records of five patients (two males) with irreparable tears involving the supraspinatus and infraspinatus tendons managed by arthroscopic-assisted LD tendon transfer were retrospectively reviewed. Clinical outcomes were assessed using the visual analogue scale (VAS) pain scale, American Shoulder and Elbow Surgeon’s (ASES) scores, the University of California Los Angeles (UCLA) scale, and ranges of motion. Postoperative integrities of transferred tendon were evaluated by magnetic resonance imaging in 4 patients and by ultrasound in one.Results: Mean patient age was 55 years (range, 48?61 years), and mean follow-up period was 20 months (range, 12.0?27.2 months). Mean VAS score significantly improved from 6.6 ± 2.6 preoperatively to 1.8 ± 2.5 postoperatively (<i>p</i>=0.009), mean ASES score increased from 67.6 ± 9.2 to 84.6 ± 15.1, and mean UCLA score from 18.0 ± 1.4 to 28.8 ± 8.5 (all <i>p</i><0.001). Postoperative imaging of the transferred LD tendon showed intact repair in 4 patients. The remaining patient experienced LD transfer rupture and a poor outcome.Conclusions: Arthroscopic-assisted LD tendon transfer improved shoulder pain and function in patients with massive, irreparable rotator cuff tears, and may be an option for this condition, especially in physically active patients.

Association of Arthroscopically-Assisted Latissimus Dorsi Tendon Transfer with Implantation of a Subacromial Balloon Spacer for Patients with Irreparable Posterosuperior Rotator Cuff Tears

“…This difference is of great impact on both the course of surgery and its outcomes. In 2019, Lim et al (11) described a series of aLDT using a dermal patch, whereas, in 2016, Kanath and colleagues (16) used a fascia lata autograft. The technique described in this study is in agreement with Kany's 2014 study (22).…”

“…Over the years, several surgeries, or combinations thereof, have been proposed (5)(6)(7)(8)(9)(10). Among these, tendon transfers, initially studied for nerve injuries, are supported by biomechanical and clinical investigations describing their results in generally small to medium series (11)(12)(13)(14)(15)(16)(17)(18)(19). Transfer of the latissimus dorsi (LDT) on the greater tuberosity, at the level of the bicipital groove, transforms this muscle from an internal rotator to an external rotator (20,21).…”

Treatment of irreparable rotator cuff tears with superior capsular reconstruction

“…Latissimus dorsi transfer has also been performed in patients with irreparable rotator cuff tears. Some investigators reported that latissimus dorsi transfer improved shoulder pain and function in physically active patients [ 8 , 21 ]. However, these were retrospective studies and the number of the subjects was small.…”

Tear pattern after superior capsular reconstruction using an acellular dermal matrix allograft

“…Irreparable rotator cuff tear has various treatment options 10,19,23,26,28,34 ; however, superior capsular reconstruction (SCR) has been increasingly adopted in younger patients. 4,5,9,15,17,25,34 Mihata et al first reported graft healing in 20 of 24 patients (83%) who underwent SCR with autogenous tensor fascia lata (TFL).…”