Biomechanical comparison of combined latissimus dorsi and teres major tendon transfer vs. latissimus dorsi tendon transfer in shoulders with irreparable anterosuperior rotator cuff tears

Baek, Gyu Rim; Kim, Jung Gon; Kwak, Daniel; Nakla, Andrew; Chung, Min-Shik; McGarry, Michelle H.; Lee, Thay Q.

doi:10.1016/j.jse.2022.11.007

Cited by 8 publications

(3 citation statements)

References 35 publications

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“…For them, alternative options, such as latissimus dorsi and teres major tendon transfer, which have recently gained considerable attention, could be considered. 2 This study has several limitations. First, being a retrospective study, it has inherent limitations.…”

Section: Discussionmentioning

confidence: 92%

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Arthroscopic Repair of Large Subscapularis Tear Over the First Facet

Kim,

Park

et al. 2023

Am J Sports Med

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Background: Long-term studies on arthroscopic repair of large subscapularis (SSC) tears over the first facet with or without supraspinatus (SSP) tear are limited. Purpose: To assess the structural and clinical outcomes of arthroscopic repair of large SSC tears using magnetic resonance imaging (MRI) and identify the factors related to SSC retear and poor outcomes. Study Design: Case series; Level of evidence, 4. Methods: This study involved 109 patients (84.0 ± 36.2 months of follow-up) who underwent arthroscopic repair of large SSC tears (Yoo and Rhee classification type III [n = 81] or IV [n = 28]) between 2011 and 2019. All patients underwent MRI at 6.1 ± 0.4 months after surgery, and 79 of 109 patients (72.5%) were followed up over 7 years. Clinical outcomes (active range of motion, functional scores, and belly press strength) and final poor clinical outcomes (reoperation, osteoarthritic change, and poor clinical outcome) were recorded. SSP tear size, rotator cuff atrophy and fatty infiltration (Goutallier classification), SSC tendon integrity (intact, intermediate, definite tear), and SSP tendon integrity (Sugaya classification) were evaluated by MRI. Results: The overall SSC retear rate was 8.3% (9/109) (type III, 2/81 [2.5%]; type IV, 7/28 [25.0%]; P < .001). SSC Goutallier grade 4 showed a higher retear rate than grade 3 (7/33 [21.2%] vs 2/33 [6.1%]; P = .149). A large SSP tear (in millimeters) (odds ratio [OR], 1.5; P = .003), SSC Goutallier grade 4 (OR, 10.8; P = .047), and SSP Goutallier grade 3 or 4 (OR, 0.02; P = .013) were independent factors for SSC retear. Clinical outcomes, except for external rotation, were poorer in patients with SSC retear than in those without retear. Final poor clinical outcomes were observed in 27 of 79 patients (34.2%); female sex (OR, 7.7; P = .007), SSC retear (OR, 8.2; P = .025), and SSP retear (OR, 4.7; P = .031) were independent factors. Conclusion: Arthroscopic repair of large SSC tears has shown promising structural outcomes for type III tears but not type IV tears. SSC retear was affected by SSC atrophy, as well as SSP tear size and atrophy. Approximately one-third of the final poor clinical outcomes could be predicted, and SSC retear, SSP retear, and female sex were associated with long-term poor clinical outcomes, underscoring the importance of carefully selecting patients for arthroscopic repair of large SSC tears.

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Section: Discussionmentioning

confidence: 92%

“…For them, alternative options, such as latissimus dorsi and teres major tendon transfer, which have recently gained considerable attention, could be considered. 2…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Repair of Large Subscapularis Tear Over the First Facet

Kim,

Park

et al. 2023

Am J Sports Med

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“…The scapula was secured to the shoulder testing system in an average anatomic position with a 20°a nterior tilt. 7,14 An aluminum rod within a cylinder was inserted into the medullary canal of the humeral shaft, and the periphery of the humerus was then fastened using screws. The rod was connected to the custom testing system through a hollow digital goniometer (Novotechnik), which enabled humeral axial rotation measurement.…”

Section: Testing Setupmentioning

confidence: 99%

Biomechanical Comparison Between Superior Capsular Reconstruction and Lower Trapezius Tendon Transfer in Irreparable Posterosuperior Rotator Cuff Tears

Baek,

Kim,

Baek

et al. 2024

Am J Sports Med

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Background: Superior capsular reconstruction (SCR) and lower trapezius tendon transfer (LTT) have recently been used to manage irreparable posterosuperior rotator cuff tears (PSRCTs). There has been a paucity of comparative biomechanical considerations between the 2 procedures. Purpose: To compare the glenohumeral stability and biomechanical properties between SCR and LTT in PSRCTs involving the entire infraspinatus tendon region. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders were tested at 0°, 20°, and 40° of shoulder abduction. Maximum internal, external, and total humeral range of motion (ROM), superior translation of the humeral head, and subacromial contact characteristics were compared among 4 conditions: (1) intact rotator cuff, (2) PSRCTs involving the entire infraspinatus tendon region, (3) LTT using Achilles allograft (12 N and 24 N of loading), and (4) SCR using fascia lata allograft. Results: Although a decrease in total ROM was noted in LTT with 12 N compared with the tear condition, LTT with both 12 N and 24 N as well as SCR did not restrict total rotational ROM compared with the intact condition. LTT had decreased total ROM compared with tear condition at 20° of abduction ( P = .042), while no significant decrease was confirmed at all abduction angles after SCR. SCR and LTT with 24 N decreased superior translation compared with the PSRCT condition at 0° and 20° of abduction ( P < .037) but not significantly at 40° of abduction, whereas LTT with a 24-N load decreased glenohumeral superior translation at all abduction angles ( P < .039). Both SCR and LTT decreased subacromial contact pressure compared with the tear condition ( P < .014) at all abduction angles. SCR decreased subacromial contact pressure at 0° and 40° of abduction ( P = .019 and P = .048, respectively) compared with LTT with 12 N of loading, while there was no difference between SCR and LTT with 24 N of loading in all abduction angles. SCR increased the contact area compared with the PSRCT condition at all abduction angles ( P < .023), whereas LTT did not increase the contact area. Conclusion: SCR and LTT decreased glenohumeral superior translation and contact pressure compared with PSRCT conditions. The LTT was superior to SCR in terms of superior translation of the humeral head at a higher shoulder abduction angle, whereas the SCR showed more advantageous subacromial contact characteristics compared with LTT. Clinical Relevance: These biomechanical findings provide insights into these 2 fundamentally different procedures for the treatment of young and active patients with PSRCTs involving the entire infraspinatus tendon region.

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Epikondylopathie des Ellenbogens

Rippke

Burkhart

2023

Orthopädie

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Biomechanical comparison of combined latissimus dorsi and teres major tendon transfer vs. latissimus dorsi tendon transfer in shoulders with irreparable anterosuperior rotator cuff tears

Cited by 8 publications

References 35 publications

Arthroscopic Repair of Large Subscapularis Tear Over the First Facet

Arthroscopic Repair of Large Subscapularis Tear Over the First Facet

Biomechanical Comparison Between Superior Capsular Reconstruction and Lower Trapezius Tendon Transfer in Irreparable Posterosuperior Rotator Cuff Tears

Epikondylopathie des Ellenbogens

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