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Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique to improve tendon transfer integrity.
J Bone Joint Surg Am 2009; 91(8):1924-31JB

Abstract

BACKGROUND

Latissimus dorsi tendon transfer is a well-established method for the treatment of massive irreparable posterosuperior defects of the rotator cuff. Subsequent rupture of the transferred tendon may contribute to the rate of failure of the index procedure. We hypothesized that modification of our technique of tendon harvesting would lead to greater fixation stability and a reduced failure rate.

METHODS

Forty-two patients (mean age, fifty-eight years) with a massive irreparable posterosuperior tear of the rotator cuff were managed with a latissimus dorsi tendon transfer. Sharp separation of the latissimus tendon from the humerus was performed in twenty-two patients (Group A), whereas the tendon harvest was carried out with a modified technique that involved removal of some bone along with the tendon at the humeral insertion in a subsequent group of twenty patients (Group B). The mean duration of follow-up was forty-seven months. Outcome measures included the Constant and American Shoulder and Elbow Surgeons (ASES) scores and a patient subjective satisfaction scale. Standard radiographs were made to determine the stage of osteoarthritis and proximal migration of the humeral head, and magnetic resonance imaging was performed to assess the integrity of the transferred muscle.

RESULTS

In Group A, the mean Constant score improved from 43.4 preoperatively to 64.8 points at the time of follow-up and the mean ASES score improved from 49.3 to 69.6 points (p < 0.05). In Group B, the mean Constant score increased from 40.2 to 74.2 points and the mean ASES score, from 47.2 to 77.1 points (p < 0.05). The Constant pain score improved from 5.6 to 11.9 points in Group A and from 5.2 to 13.8 points in Group B. The results in Group B were significantly superior to those in Group A (p < 0.05). Magnetic resonance imaging revealed complete rupture at the tendon insertion with tendon retraction in four patients in Group A and none in Group B. The final outcome was rated as poor in 27% of the patients in Group A and in 10% in Group B.

CONCLUSIONS

Latissimus dorsi tendon transfer achieves satisfactory clinical results in most patients who have a massive irreparable posterosuperior tear of the rotator cuff. Harvesting the tendon along with a small piece of bone enables direct bone-to-bone transosseous fixation, resulting in better tendon integrity and clinical results.

Authors+Show Affiliations

Department of Traumatology, University Hospital of Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19651951

Citation

Moursy, Mohamed, et al. "Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears: a Modified Technique to Improve Tendon Transfer Integrity." The Journal of Bone and Joint Surgery. American Volume, vol. 91, no. 8, 2009, pp. 1924-31.
Moursy M, Forstner R, Koller H, et al. Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique to improve tendon transfer integrity. J Bone Joint Surg Am. 2009;91(8):1924-31.
Moursy, M., Forstner, R., Koller, H., Resch, H., & Tauber, M. (2009). Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique to improve tendon transfer integrity. The Journal of Bone and Joint Surgery. American Volume, 91(8), pp. 1924-31. doi:10.2106/JBJS.H.00515.
Moursy M, et al. Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears: a Modified Technique to Improve Tendon Transfer Integrity. J Bone Joint Surg Am. 2009;91(8):1924-31. PubMed PMID: 19651951.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique to improve tendon transfer integrity. AU - Moursy,Mohamed, AU - Forstner,Rosemarie, AU - Koller,Heiko, AU - Resch,Herbert, AU - Tauber,Mark, PY - 2009/8/5/entrez PY - 2009/8/5/pubmed PY - 2009/8/13/medline SP - 1924 EP - 31 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 91 IS - 8 N2 - BACKGROUND: Latissimus dorsi tendon transfer is a well-established method for the treatment of massive irreparable posterosuperior defects of the rotator cuff. Subsequent rupture of the transferred tendon may contribute to the rate of failure of the index procedure. We hypothesized that modification of our technique of tendon harvesting would lead to greater fixation stability and a reduced failure rate. METHODS: Forty-two patients (mean age, fifty-eight years) with a massive irreparable posterosuperior tear of the rotator cuff were managed with a latissimus dorsi tendon transfer. Sharp separation of the latissimus tendon from the humerus was performed in twenty-two patients (Group A), whereas the tendon harvest was carried out with a modified technique that involved removal of some bone along with the tendon at the humeral insertion in a subsequent group of twenty patients (Group B). The mean duration of follow-up was forty-seven months. Outcome measures included the Constant and American Shoulder and Elbow Surgeons (ASES) scores and a patient subjective satisfaction scale. Standard radiographs were made to determine the stage of osteoarthritis and proximal migration of the humeral head, and magnetic resonance imaging was performed to assess the integrity of the transferred muscle. RESULTS: In Group A, the mean Constant score improved from 43.4 preoperatively to 64.8 points at the time of follow-up and the mean ASES score improved from 49.3 to 69.6 points (p < 0.05). In Group B, the mean Constant score increased from 40.2 to 74.2 points and the mean ASES score, from 47.2 to 77.1 points (p < 0.05). The Constant pain score improved from 5.6 to 11.9 points in Group A and from 5.2 to 13.8 points in Group B. The results in Group B were significantly superior to those in Group A (p < 0.05). Magnetic resonance imaging revealed complete rupture at the tendon insertion with tendon retraction in four patients in Group A and none in Group B. The final outcome was rated as poor in 27% of the patients in Group A and in 10% in Group B. CONCLUSIONS: Latissimus dorsi tendon transfer achieves satisfactory clinical results in most patients who have a massive irreparable posterosuperior tear of the rotator cuff. Harvesting the tendon along with a small piece of bone enables direct bone-to-bone transosseous fixation, resulting in better tendon integrity and clinical results. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/19651951/Latissimus_dorsi_tendon_transfer_for_irreparable_rotator_cuff_tears:_a_modified_technique_to_improve_tendon_transfer_integrity_ L2 - http://dx.doi.org/10.2106/JBJS.H.00515 DB - PRIME DP - Unbound Medicine ER -