Achilles tendon allograft-augmented latissimus dorsi tendon transfer for the treatment of massive irreparable posterosuperior rotator cuff tears.Arch Orthop Trauma Surg 2018; 138(9):1207-1212AO
The purpose of this study was to investigate clinical outcomes following Achilles tendon allograft-augmented latissimus dorsi tendon transfer (LDTT) for the treatment of irreparable posterosuperior rotator cuff tears with a minimum of 2 years post-operative follow-up. We hypothesized that patients would show significant improvement in outcomes scores with a low failure rate.
MATERIALS AND METHODS
Patients who were treated with Achilles tendon allograft-augmented LDTT for irreparable posterosuperior rotator cuff tears with a minimum follow-up of 2 years were included. Patient-reported outcomes scores, including ASES, QuickDASH, SANE, SF-12 PCS, and satisfaction, were collected pre- and post-operatively. Pre- and post-operative scores were compared with a Wilcoxon test. Revision to reverse total shoulder arthroplasty (RTSA) was considered as failure.
Between March 2006 and November 2014, a total of 16 patients with a mean age of 49 years (range 34-57 years) were included. Minimum 2-year outcomes data were available for 14 of the 16 patients (87.5%) with a mean follow-up of 5.5 years (range 2.1-10.5 years). Two patients (12.5%) advanced to RTSA at a mean of 1.1 years following LDTT. Postoperative median subjective outcomes scores improved, but did not reach statistical significance (SF-12 PCS: 35.4-46.4, P = 0.182; ASES: 47.5-69.9, P = 0.209; QuickDASH: 57.9-31.8, P = 0.176; SANE: 40.0-39.5, P = 0.273). Median post-operative patient satisfaction was 5 on a 10-point scale (range 1-10).
Patients with irreparable rotator cuff tears treated with Achilles tendon allograft-augmented latissimus dorsi tendon transfer did not experience significant post-operative improvement in patient-reported outcomes. Thus, the use of an additional allograft-augmentation remains questionable.
LEVEL OF EVIDENCE
Retrospective case series, level IV.