S Buchmann1, J E Plath, A B Imhoff. 1. Orthopädische Chirurgie, Schulthess Klinik, Zürich, Schweiz. stefan.buchmann@kws.ch
Abstract
OBJECTIVE: Improvement of glenohumeral dynamic centering and active external rotation by a transfer of the latissimus dorsi tendon to the greater tuberosity or the lateral proximal humerus. INDICATIONS: Irreparable posterosuperior rotator cuff tears. CONTRAINDICATIONS: Cuff tear arthropathy, subscapularis tendon tear, deltoid insufficiency, palsy of the axillary nerve. SURGICAL TECHNIQUE: Diagnostic arthroscopy in lateral decubitus position. Placement of suture through the biceps tendon and supragleonidal tenotomy. Posterior approach. Preparation and mobilization of a pedicled latissimus dorsi flap. Second anterior incision with delta split. Debridement of the torn rotator cuff. Insertion of suture anchors in the greater tuberosity. Passing of the muscle flap inferior to the posterior deltoid and fixation with suture anchors to the greater tuberosity (where applicable suturing with remaining rotator cuff tissue). POSTOPERATIVE MANAGEMENT: Immobilization in a thorax abduction cast for 6 weeks. Passive exercises out of the cast (IR/ER 0-0-free and ABD/ADD free-45-0°). Active assistive exercises from week 4 postoperatively. Stepwise increase of passive range of motion from week 7. Unlimited active range of motion from week 10. RESULTS: After an average follow-up of 57.6 (SD 27.5) months 17 patients were examined clinically. The average age at time of surgery was 55.6 (SD 7.7) years. At follow-up the patients showed an average Constant score of 64.4 points (SD 17.4). The active external rotation in 0° abduction was 16° (SD 17). The 4 patients (23%) with a sonographically-detected retear of the latissimus flap presented worse clinical results.
OBJECTIVE: Improvement of glenohumeral dynamic centering and active external rotation by a transfer of the latissimus dorsi tendon to the greater tuberosity or the lateral proximal humerus. INDICATIONS: Irreparable posterosuperior rotator cuff tears. CONTRAINDICATIONS: Cuff tear arthropathy, subscapularis tendon tear, deltoid insufficiency, palsy of the axillary nerve. SURGICAL TECHNIQUE: Diagnostic arthroscopy in lateral decubitus position. Placement of suture through the biceps tendon and supragleonidal tenotomy. Posterior approach. Preparation and mobilization of a pedicled latissimus dorsi flap. Second anterior incision with delta split. Debridement of the torn rotator cuff. Insertion of suture anchors in the greater tuberosity. Passing of the muscle flap inferior to the posterior deltoid and fixation with suture anchors to the greater tuberosity (where applicable suturing with remaining rotator cuff tissue). POSTOPERATIVE MANAGEMENT: Immobilization in a thorax abduction cast for 6 weeks. Passive exercises out of the cast (IR/ER 0-0-free and ABD/ADD free-45-0°). Active assistive exercises from week 4 postoperatively. Stepwise increase of passive range of motion from week 7. Unlimited active range of motion from week 10. RESULTS: After an average follow-up of 57.6 (SD 27.5) months 17 patients were examined clinically. The average age at time of surgery was 55.6 (SD 7.7) years. At follow-up the patients showed an average Constant score of 64.4 points (SD 17.4). The active external rotation in 0° abduction was 16° (SD 17). The 4 patients (23%) with a sonographically-detected retear of the latissimus flap presented worse clinical results.
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