Matthias Flury1, Sebastian Kwisda1, Christoph Kolling2, Laurent Audigé3. 1. Upper Extremities Department, Schulthess Clinic, Zürich, Switzerland. 2. Upper Extremities Department, Schulthess Clinic, Zürich, Switzerland; Research and Development Department, Schulthess Clinic, Zürich, Switzerland. 3. Upper Extremities Department, Schulthess Clinic, Zürich, Switzerland; Research and Development Department, Schulthess Clinic, Zürich, Switzerland. Electronic address: laurent.audige@kws.ch.
Abstract
HYPOTHESIS: We hypothesized that treatment of rotator cuff arthropathy (RCA) with reverse shoulder arthroplasty (RSA) and an additional latissimus dorsi transfer (LDT) in patients with an active external rotation deficit (ERD) would restore external rotation (ER) with concomitant deterioration in internal rotation. METHODS: In our cohort study, 26 RCA patients with an active ERD (ie, positive lag sign and maximum active ER of 0°) underwent RSA between September 2007 and February 2015; LDT was completed in 13 of these patients. In addition, 88 control patients without ERD who underwent only RSA were identified. Clinical outcomes of strength, range of motion, Constant-Murley score, and Shoulder Pain and Disability Index score, as well as complications, were documented 6, 12, 24, and 60 months postoperatively. We made comparative analyses using statistical mixed models. RESULTS: The LDT procedure extended the surgical time by 26 minutes (P = .003). LDT patients had up to 22° better postoperative active ER than control patients (P < .001), although this was accompanied by an internal rotation deficit (77% vs 46% of control patients could not reach the lumbosacral region, P = .010). We calculated a 23% risk of local procedure-related complications for RSA patients with an active ERD and LDT. CONCLUSION: Patients with RCA and an active ERD seem to benefit from an LDT, although this is accompanied by the potential loss of internal rotation. This additional procedure is associated with an extended surgical time as well as a possible increase in the risk of a complication occurring.
HYPOTHESIS: We hypothesized that treatment of rotator cuff arthropathy (RCA) with reverse shoulder arthroplasty (RSA) and an additional latissimus dorsi transfer (LDT) in patients with an active external rotation deficit (ERD) would restore external rotation (ER) with concomitant deterioration in internal rotation. METHODS: In our cohort study, 26 RCApatients with an active ERD (ie, positive lag sign and maximum active ER of 0°) underwent RSA between September 2007 and February 2015; LDT was completed in 13 of these patients. In addition, 88 control patients without ERD who underwent only RSA were identified. Clinical outcomes of strength, range of motion, Constant-Murley score, and Shoulder Pain and Disability Index score, as well as complications, were documented 6, 12, 24, and 60 months postoperatively. We made comparative analyses using statistical mixed models. RESULTS: The LDT procedure extended the surgical time by 26 minutes (P = .003). LDT patients had up to 22° better postoperative active ER than control patients (P < .001), although this was accompanied by an internal rotation deficit (77% vs 46% of control patients could not reach the lumbosacral region, P = .010). We calculated a 23% risk of local procedure-related complications for RSApatients with an active ERD and LDT. CONCLUSION:Patients with RCA and an active ERD seem to benefit from an LDT, although this is accompanied by the potential loss of internal rotation. This additional procedure is associated with an extended surgical time as well as a possible increase in the risk of a complication occurring.
Authors: Stephen G Thon; Adam J Seidl; Jonathan T Bravman; Eric C McCarty; Felix H Savoie; Rachel M Frank Journal: Curr Rev Musculoskelet Med Date: 2020-02
Authors: Efi Kazum; Natalia Martinez-Catalan; Giovanni Caruso; Brian A Schofield; Imen Nidtahar; Frantzeska Zampeli; Philippe Valenti Journal: Int Orthop Date: 2022-08-03 Impact factor: 3.479
Authors: Akshar V Patel; Douglas J Matijakovich; Robert L Brochin; Ryley K Zastrow; Bradford O Parsons; Evan L Flatow; Michael R Hausman; Paul J Cagle Journal: Shoulder Elbow Date: 2021-03-08
Authors: Sarav S Shah; Alexander M Roche; Spencer W Sullivan; Benjamin T Gaal; Stewart Dalton; Arjun Sharma; Joseph J King; Brian M Grawe; Surena Namdari; Macy Lawler; Joshua Helmkamp; Grant E Garrigues; Thomas W Wright; Bradley S Schoch; Kyle Flik; Randall J Otto; Richard Jones; Andrew Jawa; Peter McCann; Joseph Abboud; Gabe Horneff; Glen Ross; Richard Friedman; Eric T Ricchetti; Douglas Boardman; Robert Z Tashjian; Lawrence V Gulotta Journal: JSES Int Date: 2020-09-10
Authors: Alex Marzel; Hans-Kaspar Schwyzer; Christoph Kolling; Fabrizio Moro; Matthias Flury; Michael C Glanzmann; Christian Jung; Barbara Wirth; Beatrice Weber; Beat Simmen; Markus Scheibel; Laurent Audigé Journal: BMJ Open Date: 2020-11-26 Impact factor: 2.692