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Biomechanical effect of latissimus dorsi tendon transfer for irreparable massive cuff tear.
J Shoulder Elbow Surg 2013; 22(2):150-7JS

Abstract

BACKGROUND

The purpose of this study was to determine the biomechanical effects of latissimus dorsi transfer in a cadaveric model of massive posterosuperior rotator cuff tear.

METHODS

Eight cadaveric shoulders were tested at 0°, 30°, and 60° of abduction in the scapular plane with anatomically based muscle loading. Humeral rotational range of motion and the amount of humeral rotation due to muscle loading were measured. Glenohumeral kinematics and contact characteristics were measured throughout the range of motion. After testing in the intact condition, the supraspinatus and infraspinatus were resected. The cuff tear was then repaired by latissimus dorsi transfer. Two muscle loading conditions were applied after latissimus transfer to simulate increased tension that may occur due to limited muscle excursion. A repeated-measures analysis of variance was used for statistical analysis.

RESULTS

The amount of internal rotation due to muscle loading and maximum internal rotation increased with massive cuff tear and was restored with latissimus transfer (P < .05). At maximum internal rotation, the humeral head apex shifted anteriorly, superiorly, and laterally at 0° of abduction after massive cuff tear (P < .05); this abnormal shift was corrected with latissimus transfer (P < .05). However, at 30° and 60° of abduction, latissimus transfer significantly altered kinematics (P < .05) and latissimus transfer with increased muscle loading increased contact pressure, especially at 60° of abduction.

CONCLUSION

Latissimus dorsi transfer is beneficial in restoring humeral internal/external rotational range of motion, the internal/external rotational balance of the humerus, and glenohumeral kinematics at 0° of abduction. However, latissimus dorsi transfer with simulated limited excursion may lead to an overcompensation that can further deteriorate normal biomechanics, especially at higher abduction angles.

Authors+Show Affiliations

Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

22560227

Citation

Oh, Joo Han, et al. "Biomechanical Effect of Latissimus Dorsi Tendon Transfer for Irreparable Massive Cuff Tear." Journal of Shoulder and Elbow Surgery, vol. 22, no. 2, 2013, pp. 150-7.
Oh JH, Tilan J, Chen YJ, et al. Biomechanical effect of latissimus dorsi tendon transfer for irreparable massive cuff tear. J Shoulder Elbow Surg. 2013;22(2):150-7.
Oh, J. H., Tilan, J., Chen, Y. J., Chung, K. C., McGarry, M. H., & Lee, T. Q. (2013). Biomechanical effect of latissimus dorsi tendon transfer for irreparable massive cuff tear. Journal of Shoulder and Elbow Surgery, 22(2), pp. 150-7. doi:10.1016/j.jse.2012.01.022.
Oh JH, et al. Biomechanical Effect of Latissimus Dorsi Tendon Transfer for Irreparable Massive Cuff Tear. J Shoulder Elbow Surg. 2013;22(2):150-7. PubMed PMID: 22560227.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biomechanical effect of latissimus dorsi tendon transfer for irreparable massive cuff tear. AU - Oh,Joo Han, AU - Tilan,Justin, AU - Chen,Yu-Jen, AU - Chung,Kyung Chil, AU - McGarry,Michelle H, AU - Lee,Thay Q, Y1 - 2012/05/03/ PY - 2011/08/09/received PY - 2012/01/19/revised PY - 2012/01/23/accepted PY - 2012/5/8/entrez PY - 2012/5/9/pubmed PY - 2013/6/19/medline SP - 150 EP - 7 JF - Journal of shoulder and elbow surgery JO - J Shoulder Elbow Surg VL - 22 IS - 2 N2 - BACKGROUND: The purpose of this study was to determine the biomechanical effects of latissimus dorsi transfer in a cadaveric model of massive posterosuperior rotator cuff tear. METHODS: Eight cadaveric shoulders were tested at 0°, 30°, and 60° of abduction in the scapular plane with anatomically based muscle loading. Humeral rotational range of motion and the amount of humeral rotation due to muscle loading were measured. Glenohumeral kinematics and contact characteristics were measured throughout the range of motion. After testing in the intact condition, the supraspinatus and infraspinatus were resected. The cuff tear was then repaired by latissimus dorsi transfer. Two muscle loading conditions were applied after latissimus transfer to simulate increased tension that may occur due to limited muscle excursion. A repeated-measures analysis of variance was used for statistical analysis. RESULTS: The amount of internal rotation due to muscle loading and maximum internal rotation increased with massive cuff tear and was restored with latissimus transfer (P < .05). At maximum internal rotation, the humeral head apex shifted anteriorly, superiorly, and laterally at 0° of abduction after massive cuff tear (P < .05); this abnormal shift was corrected with latissimus transfer (P < .05). However, at 30° and 60° of abduction, latissimus transfer significantly altered kinematics (P < .05) and latissimus transfer with increased muscle loading increased contact pressure, especially at 60° of abduction. CONCLUSION: Latissimus dorsi transfer is beneficial in restoring humeral internal/external rotational range of motion, the internal/external rotational balance of the humerus, and glenohumeral kinematics at 0° of abduction. However, latissimus dorsi transfer with simulated limited excursion may lead to an overcompensation that can further deteriorate normal biomechanics, especially at higher abduction angles. SN - 1532-6500 UR - https://www.unboundmedicine.com/medline/citation/22560227/Biomechanical_effect_of_latissimus_dorsi_tendon_transfer_for_irreparable_massive_cuff_tear_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1058-2746(12)00063-8 DB - PRIME DP - Unbound Medicine ER -