Outcome Comparison of Latissimus Dorsi Transfer and Pectoralis Major Transfer for Irreparable Subscapularis Tendon Tear: A Systematic Review

Abstract

Background: Latissimus dorsi transfer (LDT) and pectoralis major transfer (PMT) were developed to treat an irreparable subscapularis tendon tear (ISScT); however, the difference in their outcomes remains unclear. Purpose: To systematically review and compare the outcomes of LDT and PMT for ISScT. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed through a comprehensive search of Embase, PubMed, and the Cochrane Library. Studies of LDT or PMT were included according to the inclusion and exclusion criteria. The primary outcome was the Constant-Murley score (CMS) at the final follow-up. Secondary outcomes included the subjective shoulder value (SSV), visual analog scale (VAS) score for pain, active shoulder range of motion, and the belly-press and lift-off tests. Postoperative failure and complication rates were the safety outcome measures. Outcomes were summarized into the LDT and PMT groups, and results were compared statistically ( P < .05). Results: Twelve studies were included in this review: 184 shoulders from 9 studies for the PMT group and 85 shoulders from 3 studies for the LDT group. For the PMT and LDT groups, the mean ages were 58.9 and 55.1 years, respectively, and the mean follow-up was 66.9 and 17.4 months, respectively. Overall, the LDT and PMT groups improved in the primary outcome (CMS) and secondary outcomes (SSV, VAS, ROM, and belly-press and lift-off tests), with low rates of failure and complication. When compared with the PMT group, the LDT group showed more significant improvements in CMS (35.2 vs 24.7; P < .001), active forward flexion (44.3° vs 14.7°; P < .001), abduction (35.0° vs 17.6°; P < .002), and positive belly-press test rate (45% vs 27%; P < .001). No statistically significant difference was seen between the groups in postoperative failure rate, complication rate, mean improvement of active internal rotation, VAS, or SSV. Conclusion: In general, LDT showed significantly better clinical outcomes postoperatively than did PMT. The available fair-quality evidence suggested that LDT might be a better choice for ISScT. Further evaluations on the relative benefits of the 2 surgical approaches are required, with more high-quality randomized controlled studies.

Open Anterior Capsular Reconstruction With a Dermal Allograft Is a Viable Nonarthroplasty Salvage Procedure for Irreparable Subscapularis Tears at a Minimum 2-Year Follow-up

“…However, when each are expressed as a percentage of the best possible score, Constant–Murley scores are 63% and 69% in the PMT and LDT groups, respectively, whereas the mean ASES score in our cohort is 89%. 24 Luo et al. 24 reported failure rates of 12.9% for PMT and 7.1% for LDT which is comparable to our failure rate of 14.3% (1 patient).…”

“… 8 , 10 In a recent systematic review, Luo et al. 24 reviewed 9 PMT and 3 LDT studies reporting average postoperative Subjective Shoulder Value scores of 71 for PMT and 70 for LDT. These values are comparable to our cohort’s average SANE score of 71, an outcome measure analogous to the Subjective Shoulder Value.…”

Comparing KTP and CO2 laser excision for recurrent respiratory papillomatosis: A systematic review

“…Due to the abundance of non‐randomized studies in the included literature, two reviewers (JY and ZX) critically appraised (independently) all eligible studies against the Methodological Index for Nonrandomized Studies (MINORS) to assess their quality. 32 , 33 A senior reviewer (ZL) made the final assessment decision when consensus could not be achieved. The MINORS instrument contains 12 items (Supporting Information S3 ): eight for noncomparative studies with an additional four for comparative studies.…”

Relationship between the Hamada Grade and underlying pathological conditions in the rotator cuff and long head of biceps in symptomatic patients with rotator cuff tears

“…In this study, Grades 4A, 4B, and 5 were grouped together as Grade 4-5 because these grades are characterized by glenohumeral arthritis with massive RCT, which is often used as an exclusion criterion for joint-preserving surgery and a good indication for reverse shoulder arthroplasty. 3 , 10 , 24

Figure 1 Classification of Hamada Grade. ( A ) Grade 1, the acromiohumeral interval is 6 mm or more.

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“… 14 , 15 Recently, preoperative radiographic evaluation according to the Hamada classification has been widely used to determine the indication for joint-preserving surgery in patients with symptomatic RCTs. 5 , 8 , 15 , 19 , 24 , 26 , 39 In addition, some studies have reported that progressed Hamada Grades worsen the clinical results of rotator cuff surgery. 8 , 15 , 29 However, the correlation between the severity of the Hamada Grade and the underlying rotator cuff and long head of the biceps (LHB) pathologies remains unclear.…”