Wednesday, June 6, 2012

Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears - JBJS

The recent JBSJ article “Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears” provides a thoughtful systematic review of the data on this procedure by two independent reviewers. They present the frequency-weighted data averages as follows: age 59 years, follow-up 46 months, preoperative Constant score 46, post operative Constant score 73, preoperative active elevation 102, postoperative active elevation of 137.

The complication rate was 10% and reoperation rate was 7%. Factors predictive of a poorer result included prior failed cuff repair, subscapularis insufficiency, and advanced teres minor muscle atrophy.

The authors are careful to point out that these studies did not compare latissimus transfer to other operative and non-operative treatments. They were unable to determine whether a single-incision or dual incision approaches yielded better results, whether adding a teres major transfer improved the results, or whether the transfer had an effect on the progression of shoulders with large cuff tears toward rotator cuff arthropathy.

It is worth pointing out that the articles reviewed in this investigation each had a substantial number of cases (range 10-75), thus the results are those of experienced surgeons. Those surgeons considering this procedure for the first time are advised to carefully review the technical details and to practice them in cadaver specimens.


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