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Arthroscopically-Assisted Latissimus Dorsi Transfer for Irreparable Rotator Cuff Insufficiency: Modes of Failure and Clinical Correlation.
Arthroscopy 2018; 34(4):1139-1150A

Abstract

PURPOSE

The main objective of this retrospective study was to analyze the rate and modes of failure of latissimus dorsi transfer (LDT). The secondary objective was to evaluate whether a rupture of the transfer was associated with a worse outcome.

METHODS

During a 2-year period, we performed consecutive LDTs either for irreparable posterior-superior rotator cuff tears (RCTs) or for failed prior repair. All the LDTs were performed by a single surgeon. All transfers were arthroscopically assisted and fixed as a tubularized LD tendon in a bone tunnel inside the humeral head. Three metal clips were placed systematically intraoperatively in the tubularized tendon at a fixed distance of 2, 4, and 6 cm from the tip of the tendon. Immediate postoperative standard anteroposterior radiographs were performed and the position of the metal clips was compared with their position on radiographs performed at 6 weeks and 3 and 24 months postoperatively. Constant, Subjective Shoulder Value (SSV), Simple Shoulder Test (SST), Activities of daily living requiring active external rotation (ADLER), visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) scores and patient's subjective satisfaction (assessed by self-questionnaire) at last follow-up were compared between patients who had a rupture of the transfer and those who did not.

RESULTS

Sixty-six patients were included. Six of 66 patients (9%) were lost to follow-up. There were 11 complications (18.3%) in the global series (10 hematoma and 1 subscapularis retear). At a mean 35.2 months (range 24-50 months), there were 23/60 cases of rupture (38%). The 7 scores and the satisfaction reported were significantly lower for patients who had a rupture of the transfer versus those who had an intact transfer: Constant score, 42.8 versus 68.7 (P = .001); SSV, 48.9 versus 71.6 (P = .001); SST, 4.8 versus 8.4 (P = .012); ADLER, 19.7 versus 26.7 (P = .005); VAS, 3.7 versus 2.3 (P = .082); ASES, 55.4 versus 74.8 (P = .056); and 13% of either satisfied or very satisfied patients versus 78% (P < .001).

CONCLUSIONS

The rate of rupture of LDT is high (38%). With complete healing of LDT, the outcome is significantly lower in those with rupture compared with those without rupture, showing that LDT can efficiently treat massive and irreparable RCT.

LEVEL OF EVIDENCE

Level IV, case series treatment study.

Authors+Show Affiliations

Clinique de l'Union, Saint Jean, France. Electronic address: jean.kany@clinique-union.fr.LIRCOS, Paris, France.Department of Orthopedics, Arthroscopy and Sports Medicine, St John's Medical College Hospital, Bangalore, India.Department of Physiotherapy and Rehabilitation, Sparsh Hospital for Advanced Surgeries, Bangalore, India.Clinique de l'Union, Saint Jean, France.Clinique Bizet, Paris, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29361422

Citation

Kany, Jean, et al. "Arthroscopically-Assisted Latissimus Dorsi Transfer for Irreparable Rotator Cuff Insufficiency: Modes of Failure and Clinical Correlation." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 34, no. 4, 2018, pp. 1139-1150.
Kany J, Grimberg J, Amaravathi RS, et al. Arthroscopically-Assisted Latissimus Dorsi Transfer for Irreparable Rotator Cuff Insufficiency: Modes of Failure and Clinical Correlation. Arthroscopy. 2018;34(4):1139-1150.
Kany, J., Grimberg, J., Amaravathi, R. S., Sekaran, P., Scorpie, D., & Werthel, J. D. (2018). Arthroscopically-Assisted Latissimus Dorsi Transfer for Irreparable Rotator Cuff Insufficiency: Modes of Failure and Clinical Correlation. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 34(4), pp. 1139-1150. doi:10.1016/j.arthro.2017.10.052.
Kany J, et al. Arthroscopically-Assisted Latissimus Dorsi Transfer for Irreparable Rotator Cuff Insufficiency: Modes of Failure and Clinical Correlation. Arthroscopy. 2018;34(4):1139-1150. PubMed PMID: 29361422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Arthroscopically-Assisted Latissimus Dorsi Transfer for Irreparable Rotator Cuff Insufficiency: Modes of Failure and Clinical Correlation. AU - Kany,Jean, AU - Grimberg,Jean, AU - Amaravathi,Rajkumar S, AU - Sekaran,Padmanaban, AU - Scorpie,Dan, AU - Werthel,Jean David, PY - 2017/06/27/received PY - 2017/10/17/revised PY - 2017/10/21/accepted PY - 2018/1/24/pubmed PY - 2019/9/5/medline PY - 2018/1/24/entrez SP - 1139 EP - 1150 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 34 IS - 4 N2 - PURPOSE: The main objective of this retrospective study was to analyze the rate and modes of failure of latissimus dorsi transfer (LDT). The secondary objective was to evaluate whether a rupture of the transfer was associated with a worse outcome. METHODS: During a 2-year period, we performed consecutive LDTs either for irreparable posterior-superior rotator cuff tears (RCTs) or for failed prior repair. All the LDTs were performed by a single surgeon. All transfers were arthroscopically assisted and fixed as a tubularized LD tendon in a bone tunnel inside the humeral head. Three metal clips were placed systematically intraoperatively in the tubularized tendon at a fixed distance of 2, 4, and 6 cm from the tip of the tendon. Immediate postoperative standard anteroposterior radiographs were performed and the position of the metal clips was compared with their position on radiographs performed at 6 weeks and 3 and 24 months postoperatively. Constant, Subjective Shoulder Value (SSV), Simple Shoulder Test (SST), Activities of daily living requiring active external rotation (ADLER), visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) scores and patient's subjective satisfaction (assessed by self-questionnaire) at last follow-up were compared between patients who had a rupture of the transfer and those who did not. RESULTS: Sixty-six patients were included. Six of 66 patients (9%) were lost to follow-up. There were 11 complications (18.3%) in the global series (10 hematoma and 1 subscapularis retear). At a mean 35.2 months (range 24-50 months), there were 23/60 cases of rupture (38%). The 7 scores and the satisfaction reported were significantly lower for patients who had a rupture of the transfer versus those who had an intact transfer: Constant score, 42.8 versus 68.7 (P = .001); SSV, 48.9 versus 71.6 (P = .001); SST, 4.8 versus 8.4 (P = .012); ADLER, 19.7 versus 26.7 (P = .005); VAS, 3.7 versus 2.3 (P = .082); ASES, 55.4 versus 74.8 (P = .056); and 13% of either satisfied or very satisfied patients versus 78% (P < .001). CONCLUSIONS: The rate of rupture of LDT is high (38%). With complete healing of LDT, the outcome is significantly lower in those with rupture compared with those without rupture, showing that LDT can efficiently treat massive and irreparable RCT. LEVEL OF EVIDENCE: Level IV, case series treatment study. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/29361422/Arthroscopically_Assisted_Latissimus_Dorsi_Transfer_for_Irreparable_Rotator_Cuff_Insufficiency:_Modes_of_Failure_and_Clinical_Correlation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(17)31441-X DB - PRIME DP - Unbound Medicine ER -