Abstract
PURPOSE: To evaluate the clinical success rate, along with risk factors for failure, in patients undergoing latissimus dorsi transfer for the treatment of massive, irreparable, previously failed rotator cuff tears.
METHODS: We performed a retrospective chart review of prospectively collected data from an institutional shoulder outcome registry. All patients who underwent latissimus dorsi transfer for previously failed rotator cuff repair between 2006 and 2013 with a minimum follow-up period of 1 year were included in the study. The indications for inclusion were large (≥2 tendons), retracted, chronic rotator cuff tears with fatty infiltration or atrophy for which prior surgical repair had failed. Preoperative and postoperative American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test scores were collected, along with postoperative Single Assessment Numerical Evaluation scores. Complications and clinical failures (Δ in ASES score <17) were recorded. Patient demographic and tear characteristics were evaluated as potential risk factors for failure.
RESULTS: A total of 22 patients (mean age, 53 ± 6 years) were included in the study, with a mean follow-up time of 3.4 ± 1.1 years. Over 63% of patients (n = 14) reported undergoing 2 or more prior failed rotator cuff repairs. Patients undergoing latissimus dorsi transfer showed significant improvements in ASES scores (from 35.2 ± 21.9 preoperatively to 55.8 ± 22.9 postoperatively, P = .001), Simple Shoulder Test scores (from 3.5 ± 3.1 preoperatively to 5.2 ± 3.4 postoperatively, P = .002), and pain scores (from 5.9 ± 2.8 preoperatively to 4.6 ± 4.3 postoperatively, P = .002) at final follow-up. The complication rate after latissimus transfer was 27%. The rate of revision to reverse total shoulder arthroplasty was 13.6% (n = 3) after a mean of 2.7 years, and the clinical failure rate was 41% (n = 9) at final follow-up. An acromiohumeral interval of less than 7 mm (P = .04) and high-grade fatty infiltration (grade 3 or greater, P = .004) were significant preoperative risk factors for clinical failure.
CONCLUSIONS: Latissimus dorsi tendon transfer resulted in a clinical failure rate of 41% and complication rate of 27%, with an acromiohumeral interval of less than 7 mm and high-grade fatty infiltration being associated with postoperative failure.
LEVEL OF EVIDENCE: Level IV.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 88-94 |
| Number of pages | 7 |
| Journal | Arthroscopy - Journal of Arthroscopic and Related Surgery |
| Volume | 36 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2020 |
Bibliographical note
Funding Information:The authors report the following potential conflicts of interest or sources of funding: D.M.A. receives consulting fees from Dunamis Medical. M.P.C. receives personal fees from the Arthroscopy Association of North America (Arthroscopy). R.A.A. receives research support from Arthrex and consulting fees from Biorez. A.D.M. is a paid consultant for and receives research support from Arthrex. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Publisher Copyright:
© 2019 Arthroscopy Association of North America
Keywords
- Female
- Follow-Up Studies
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Postoperative Period
- Retrospective Studies
- Rotator Cuff/diagnostic imaging
- Rotator Cuff Injuries/diagnosis
- Rupture
- Shoulder Joint/diagnostic imaging
- Superficial Back Muscles/diagnostic imaging
- Tendon Transfer/methods
- Tendons/surgery
- Treatment Outcome
PubMed: MeSH publication types
- Research Support, Non-U.S. Gov't
- Journal Article