Augmented latissimus dorsi transfer: initial results in patients with massive irreparable posterosuperior rotator cuff tears

Abstract

Background: The surgical treatment of irreparable massive rotator cuff tears is challenging. The purpose of the present study was to report the initial outcomes after a modified latissimus dorsi transfer (LDT) augmented by acellular dermal allograft (ADA). Methods: This retrospective study includes 24 patients managed with LDT using ADA augmentation as a bursal-sided onlay between March 2009 and December 2015. Results: All patients were men with a mean age of 57 years (range 48 years to 70 years). Seven patients had a previously failed rotator cuff repair and ten patients presented with a deficient subscapularis tendon. At last follow-up (mean 27 months), there was a significant improvement in active forward flexion (mean increase 31 ; p ¼ 0.016), and abduction by 25 (p ¼ 0.059). The acromiohumeral distance remained stable and the failure rate was low (4%). Neither a history of previous rotator cuff surgery, nor the presence of a subscapularis tear had a negative impact on functional outcome. Conclusions: In our cohort of patients, LDT augmented with ADA was a reasonable option for patients with previously failed rotator cuff repair, as well as in the subgroup of patients with a deficient subscapularis tendon.

High Clinical Failure Rate After Latissimus Dorsi Transfer for Revision Massive Rotator Cuff Tears

“…They recommended performing an acromial osteotomy to limit disruption of the deltoid tendon and an augmentation repair using a collagen matrix. Sidler-Maier et al 32 presented preliminary outcomes using a bursal sideeonly dermal augmentation in patients with massive posterosuperior tears. At a mean follow-up of 27 months, patients reported significant improvements in forward flexion and all but 1 of the 24 patients reported being "satisfied" with their operation.…”

“…The authors did not find previous surgery, tendon retraction, or atrophy to have an effect on postoperative motion. 32 Although reverse total shoulder arthroplasty is a viable salvage procedure, implant longevity and failure preclude the use of arthroplasty in this young and active population. 33 Whereas latissimus dorsi tendon transfer is thought to restore external rotation and re-establish the anterior-posterior force couples on the humeral head, the orientation of the tenodesis places a nonphysiological vector across the shoulder joint.…”

Biomechanical analysis of arthroscopically assisted latissimus dorsi transfer fixation for irreparable posterosuperior rotator cuff tears—Knotless versus knotted anchors

“…Previous reports emphasized therefore the use of an additional allograft tendon to cover and further reinforce the tendon suture interface. 21,22 This biomechanical study showed that the used 5-crossings stitching technique (Figure 4) provided a solid and strong tendon reinforcement, as tendon pull-out was only observed once as a failure mode.…”

Nonarthroplasty options for massive, irreparable rotator cuff tears have improvement in range of motion and patient-reported outcomes at short-term follow-up: a systematic review

“…1). There were 3 Level II studies, [52, 71, 87], 14 Level III studies [10, 18, 39, 42, 49, 50, 53, 55, 56, 62, 63, 65, 68, 76], and 69 Level IV studies [3, 4, 6, 8, 9, 11–13, 15–17, 19–33, 35, 37, 38, 41, 43, 45, 47, 48, 51, 54, 57–61, 64, 66, 67, 69, 72–75, 77–81, 84–86, 88–95]. The mean MINORS score was 18 for the 14 comparative studies and 8 for the 69 noncomparative studies.…”

“…A total of 39 studies reported revision rates, with all 6 subgroups represented (Table 9). There were two studies in the allograft bridging/augmentation subgroup [62, 92], one study in the debridement subgroup [33], four studies in the repair subgroup [24, 52, 53, 74], eight studies in the SCR subgroup [6, 16, 42, 45, 48, 55, 58, 85], 6 studies in the spacer subgroup [17, 53, 54, 72, 75, 93], and 19 studies in the tendon transfer subgroup [9, 15, 20, 25, 27, 29, 30, 32, 37–39, 43, 49, 64, 70, 81, 87, 94, 95]. The overall revision rate of all studies was 7.4%.…”