Journal List > J Korean Soc Surg Hand > v.21(4) > 1106534

Park, Choi, Noh, Kim, Kim, Hwang, and Bae: Latissimus Dorsi Tendon Transfer for the Treatment of Irreparable Rotator Cuff Tears

Abstract

Purpose:

Massive and irreparable rotator cuff tears present a difficult treatment problem, and if further progressed, then cuff tear arthropaty may develop. We treated seven cases of massive rotator cuff tears with latissimus dorsi tendon transfer and report their clinical results.

Methods:

Seven patients of mean age of 64 years (range, 51–70 years) with irreparable massive rotator cuff tears were treated using latissimus dorsi tendon transfer. The latissimus dorsi flap was harvested through an axillary approach and reattached on the greater tuberosity, using transosseous suture with nonabsorbable sutures. Outcomes were assessed clinically and radiographically after an average of 48 months (range, 28–68 months).

Results:

The VAS pain scores improved from 6.3 to 3.3 points (p=0.019). Forward flexion increased from 62° to 105°, abduction increased from 49° to 94°, and external rotation increased from 15° to 34°. Postoperative antero-posterior radiography revealed a mean 0.1 mm depression of the humeral head, without statistical the mean American Shoulder and Elbow Surgeons score improved from 44 to 76. The acromiohumeral distance showed slight increase in amount of 0.1 mm without statistical significance. There was no complication.

Conclusion:

Latissimus dorsi transfer is a useful surgical option for treating irreparable massive rotator cuff tears.

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Fig. 1.
A 68 year-old-male patient with a massive cuff tear shows limitation in forward flexion and abduction.
jkssh-21-181f1.tif
Fig. 2.
Magnetic resonance imaging of the shoulder shows tendon tear with severe retraction, fatty degeneration of the supraspinatus muscle and superior migration of humeral head.
jkssh-21-181f2.tif
Fig. 3
(A) Intraoperative photograph showing massive cuff tear (dotted line). (B) Operative photograph showing a latissimus dorsi muscle-tendon unit freed from its insertion site and ready for transfer. (C) Operative photograph showing a complete repair of a rotator cuff defect with a transferred lattisimus dorsi tendon.
jkssh-21-181f3.tif
Fig. 4.
Photograph showing nearly full elevation and abduction of the right shoulder four years after operation.
jkssh-21-181f4.tif
Table 1.
Patients data
Case no. Age (yr) Sex Follow-up (mo) Goutalier et al.20 Hamada et al.1 Intraop. findings (torn muslces) Preop./Postop. measurements
VAS pain ASES Fowrad flexion (°) Abduction (°) External rotation (arm at side) (°)
1 66 Male 65 IV 2 SS, IS 6/2 48/81 60/120 45/90 10/30
2 68 Male 48 IV 2 SS, IS, Tmi 5/2 49/82 90/130 60/110 10/20
3 69 Male 47 IV 1 SS, IS 7/3 40/85 60/120 50/110 10/35
4 55 Female 45 IV 1 SS, IS, Tmi 6/3 45/86 70/120 60/110 15/60
5 67 Female 68 III 1 SS, IS, Tmi, SubS 7/6 40/70 60/90 55/85 25/45
6 51 Male 28 IV 2 SS, IS 6/2 47/79 50/100 30/100 20/35
7 70 Male 30 IV 2 SS, IS, Tmi, SubS 7/5 42/50 45/53 45/55 15/15
Mean 64 - 47.3 - - - 6.3/3.3 44.4/76.1 62.1/104.7 49.3/94.3 15/34.3

Intraop., intraoperative; Preop., preoperative; Postop., postoperative; VAS, visual analogue scale; ASES, American Shoulder and Elbow Surgeons; SS, supraspinatus; IS, infraspinatus; Tmi, teres minor; SubS, subscapularis

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