Comparison of arthroscopically assisted transfer of the latissimus dorsi with or without partial cuff repair for irreparable postero-superior rotator cuff tear.

PURPOSE: To evaluate the effect of an additional partial repair in combination with an arthroscopically assisted transfer of the latissimus dorsi (LDT) in massive postero-superior irreparable cuff tear.
MATERIALS AND METHODS: Thirty-one patients (mean age 59.2 years) scheduled for arthroscopically assisted LDT either isolated or in combination with a partial cuff repair for a massive posterior-superior cuff tear were prospectively included between January 2011 and December 2013 at our institution. Seventeen had an isolated transfer (Group A) and 14 had a transfer combined with a partial cuff repair (Group B). Outcome measures included visual analogue scale (VAS), range of motion, strength, constant score, and subjective shoulder value (SSV). Potential predictive factors were analyzed.
RESULTS: At the last follow-up (mean 22 months), patients in Group B had a significantly higher constant score (64 ± 8 versus 58 ± 4 in Group A), range of motion (33 ± 5 versus 29 ± 5 points in Group A), and strength at 90° of abduction (2.5 kg ± 1 in Group B versus 1.9 kg ± 0.9 in Group A). No significant differences were found between both groups regarding pain scores, SSV, and active external rotation. Thirty-seven variables were analyzed and the only factor which was found to be predictive of a bad result was a preoperative SSV < 40 pts. (RR 0.5).
CONCLUSION: Arthroscopically assisted LDT gives better results when combined with a partial repair of the cuff than when it is performed isolated in the treatment of massive irreparable postero-superior rotator cuff tear. LEVEL OF EVIDENCE: Treatment study, Level II.