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Does the latissimus dorsi tendon transfer for massive rotator cuff tears remain active postoperatively and restore active external rotation?
J Shoulder Elbow Surg 2014; 23(4):553-60JS

Abstract

HYPOTHESIS

The purpose of this study is to evaluate the muscle activity with surface electromyography (EMG) and the clinical outcome of the latissimus dorsi transfer. It remains unclear whether the clinical results of the latissimus dorsi transfer for massive posterosuperior rotator cuff tears are achieved either by active muscle contractions or by a passive tenodesis effect of the transfer.

METHODS

Eight patients were evaluated preoperatively and at 1 year (SD, 0.1) after the latissimus dorsi transfer. Clinical evaluation of outcomes included active range of motion, Constant score, and visual analog scale (VAS) for pain and activities of daily living (ADL). Muscle activity was recorded with EMG during directional isometric abduction and adduction tasks.

RESULTS

The external rotation in adduction improved from 23° to 51° (P = .03). The external rotation in abduction improved from 10° to 70° (P = .02). The mean Constant score improved from 39 to 62 postoperatively (P = .01). The VAS for pain at rest improved from 3.3 preoperatively to 0.1 (P = .02). The VAS for ADL improved from 4.9 to 2.3 (P = .05). The transferred latissimus dorsi remained active in all cases, as reflected by increased latissimus dorsi EMG activity during abduction tasks. In addition, the latissimus dorsi EMG activity shifted from preoperative antagonistic co-activation in adduction to synergistic activation in abduction.

CONCLUSION

The latissimus dorsi has synergistic muscle activity after transfer. Apart from a tenodesis effect, directional muscle activity seems relevant for improved clinical outcome and pain relief. A specific gain was observed for external rotation in elevated arm positions, a motion essential for ADL tasks.

Authors+Show Affiliations

Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: j.f.henseler@lumc.nl.Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, The Netherlands; Department of Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24135419

Citation

Henseler, Jan Ferdinand, et al. "Does the Latissimus Dorsi Tendon Transfer for Massive Rotator Cuff Tears Remain Active Postoperatively and Restore Active External Rotation?" Journal of Shoulder and Elbow Surgery, vol. 23, no. 4, 2014, pp. 553-60.
Henseler JF, Nagels J, Nelissen RG, et al. Does the latissimus dorsi tendon transfer for massive rotator cuff tears remain active postoperatively and restore active external rotation? J Shoulder Elbow Surg. 2014;23(4):553-60.
Henseler, J. F., Nagels, J., Nelissen, R. G., & de Groot, J. H. (2014). Does the latissimus dorsi tendon transfer for massive rotator cuff tears remain active postoperatively and restore active external rotation? Journal of Shoulder and Elbow Surgery, 23(4), pp. 553-60. doi:10.1016/j.jse.2013.07.055.
Henseler JF, et al. Does the Latissimus Dorsi Tendon Transfer for Massive Rotator Cuff Tears Remain Active Postoperatively and Restore Active External Rotation. J Shoulder Elbow Surg. 2014;23(4):553-60. PubMed PMID: 24135419.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does the latissimus dorsi tendon transfer for massive rotator cuff tears remain active postoperatively and restore active external rotation? AU - Henseler,Jan Ferdinand, AU - Nagels,Jochem, AU - Nelissen,Rob G H H, AU - de Groot,Jurriaan H, Y1 - 2013/10/14/ PY - 2013/05/06/received PY - 2013/07/17/revised PY - 2013/07/28/accepted PY - 2013/10/19/entrez PY - 2013/10/19/pubmed PY - 2014/5/27/medline KW - Rotator cuff tear KW - electromyography KW - irreparable KW - latissimus dorsi KW - tendon transfer KW - transplantation SP - 553 EP - 60 JF - Journal of shoulder and elbow surgery JO - J Shoulder Elbow Surg VL - 23 IS - 4 N2 - HYPOTHESIS: The purpose of this study is to evaluate the muscle activity with surface electromyography (EMG) and the clinical outcome of the latissimus dorsi transfer. It remains unclear whether the clinical results of the latissimus dorsi transfer for massive posterosuperior rotator cuff tears are achieved either by active muscle contractions or by a passive tenodesis effect of the transfer. METHODS: Eight patients were evaluated preoperatively and at 1 year (SD, 0.1) after the latissimus dorsi transfer. Clinical evaluation of outcomes included active range of motion, Constant score, and visual analog scale (VAS) for pain and activities of daily living (ADL). Muscle activity was recorded with EMG during directional isometric abduction and adduction tasks. RESULTS: The external rotation in adduction improved from 23° to 51° (P = .03). The external rotation in abduction improved from 10° to 70° (P = .02). The mean Constant score improved from 39 to 62 postoperatively (P = .01). The VAS for pain at rest improved from 3.3 preoperatively to 0.1 (P = .02). The VAS for ADL improved from 4.9 to 2.3 (P = .05). The transferred latissimus dorsi remained active in all cases, as reflected by increased latissimus dorsi EMG activity during abduction tasks. In addition, the latissimus dorsi EMG activity shifted from preoperative antagonistic co-activation in adduction to synergistic activation in abduction. CONCLUSION: The latissimus dorsi has synergistic muscle activity after transfer. Apart from a tenodesis effect, directional muscle activity seems relevant for improved clinical outcome and pain relief. A specific gain was observed for external rotation in elevated arm positions, a motion essential for ADL tasks. SN - 1532-6500 UR - https://www.unboundmedicine.com/medline/citation/24135419/Does_the_latissimus_dorsi_tendon_transfer_for_massive_rotator_cuff_tears_remain_active_postoperatively_and_restore_active_external_rotation L2 - https://linkinghub.elsevier.com/retrieve/pii/S1058-2746(13)00399-6 DB - PRIME DP - Unbound Medicine ER -