Manuel Waltenspül1, Benedikt Jochum2, Lukas Filli3, Lukas Ernstbrunner2, Karl Wieser2, Dominik Meyer2, Christian Gerber2. 1. Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland. Electronic address: manuel.waltenspuel@balgrist.ch. 2. Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland. 3. Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland.
Abstract
INTRODUCTION: With the progress in arthroscopic surgery, latissimus dorsi transfer (LDT) for irreparable posterosuperior rotator cuff tears (RCTs) has become a reliable all-arthroscopic or arthroscopically-assisted procedure. Mid-term results of the arthroscopically-assisted LDT (aLDT) are scarce in literature. The purpose of this study was to report our clinical and radiographic mid-term results of aLDT for irreparable posterosuperior RCTs. METHODS: Thirty-one consecutive patients with a mean age of 55.5 (Range, 38-73) years at the time of aLDT were evaluated after a mean of 3.5 (range, 2-5) years. All patients had irreparable, full-thickness tears of at least the complete supraspinatus +/- infraspinatus tendons and 14 patients (45%) had undergone previous rotator cuff repair. Seven patients (23%) needed a concomitant upper-third subscapularis repair at the time of aLDT. Mid-term results were assessed clinically and radiographically (including MRI). RESULTS: At final follow-up, four failures (14%) had undergone revision to reverse total shoulder arthroplasty (RTSA) essentially for untreatable pain. Patients revised to RTSA, had significantly higher preoperative pain levels (Constant pain scores: 6 points vs. 11 points; p=0.032) and lower Constant Score (CS) activity scores (2 points vs. 5 points; p=0.017) than the remaining 27 patients. Patients with failed previous rotator cuff repairs had significantly inferior results than patients without previous repair (mean SSV% 66 vs 88; p = 0.035) For the 27 non-revised patients, the mean relative CS improved from 63% to 76% (p=0.032), Constant pain scores from 10.5 to 12.7 (p=0.012) points and the Subjective Shoulder Value from 43% to 77% (p<0.001). Significant progression of glenohumeral arthropathy by two or more grades according to Hamada was observed in thirteen (48%) out of the 27 patients, but there was no significant difference in clinical outcome between the patients with (n=13) and those without arthropathy (n=14; p=0.923). CONCLUSIONS: Mid-term results of the arthroscopically-assisted latissimus dorsi transfer for irreparable posterosuperior RCTs is associated with significant improvement in objective and subjective outcome measures. The failure rate leading to conversion to RTSA is relatively high in this cohort. The failures were associated with unusually intense pain in low demand individuals and / or revision of failed rotator cuff repair. Long-term result of aLDT are needed to evaluate the effect of this procedure on progression of OA.
INTRODUCTION: With the progress in arthroscopic surgery, latissimus dorsi transfer (LDT) for irreparable posterosuperior rotator cuff tears (RCTs) has become a reliable all-arthroscopic or arthroscopically-assisted procedure. Mid-term results of the arthroscopically-assisted LDT (aLDT) are scarce in literature. The purpose of this study was to report our clinical and radiographic mid-term results of aLDT for irreparable posterosuperior RCTs. METHODS: Thirty-one consecutive patients with a mean age of 55.5 (Range, 38-73) years at the time of aLDT were evaluated after a mean of 3.5 (range, 2-5) years. All patients had irreparable, full-thickness tears of at least the complete supraspinatus +/- infraspinatus tendons and 14 patients (45%) had undergone previous rotator cuff repair. Seven patients (23%) needed a concomitant upper-third subscapularis repair at the time of aLDT. Mid-term results were assessed clinically and radiographically (including MRI). RESULTS: At final follow-up, four failures (14%) had undergone revision to reverse total shoulder arthroplasty (RTSA) essentially for untreatable pain. Patients revised to RTSA, had significantly higher preoperative pain levels (Constant pain scores: 6 points vs. 11 points; p=0.032) and lower Constant Score (CS) activity scores (2 points vs. 5 points; p=0.017) than the remaining 27 patients. Patients with failed previous rotator cuff repairs had significantly inferior results than patients without previous repair (mean SSV% 66 vs 88; p = 0.035) For the 27 non-revised patients, the mean relative CS improved from 63% to 76% (p=0.032), Constant pain scores from 10.5 to 12.7 (p=0.012) points and the Subjective Shoulder Value from 43% to 77% (p<0.001). Significant progression of glenohumeral arthropathy by two or more grades according to Hamada was observed in thirteen (48%) out of the 27 patients, but there was no significant difference in clinical outcome between the patients with (n=13) and those without arthropathy (n=14; p=0.923). CONCLUSIONS: Mid-term results of the arthroscopically-assisted latissimus dorsi transfer for irreparable posterosuperior RCTs is associated with significant improvement in objective and subjective outcome measures. The failure rate leading to conversion to RTSA is relatively high in this cohort. The failures were associated with unusually intense pain in low demand individuals and / or revision of failed rotator cuff repair. Long-term result of aLDT are needed to evaluate the effect of this procedure on progression of OA.
Authors: M M Schneider; M Moursy; C Gerhardt; M Kimmeyer; V Rentschler; L J Lehmann Journal: Oper Orthop Traumatol Date: 2022-02-04 Impact factor: 1.154