Thursday, October 24, 2013

Latissimus transfer for cuff tears

Does the latissimus dorsi tendon transfer for massive rotator cuff tears remain active postoperatively and restore active external rotation?

These authors evaluated the muscle activity with surface electromyography and the clinical outcome of the latissimus dorsi transfer for massive posterosuperior rotator cuff tears in 8 patients at one year after surgery.

They excluded patients with a dysfunctional subscapularis (ie, negative liftoff test) or deltoid muscle, radiographic glenohumeral joint osteoarthritis of grade 3 to 4 according to the Kellgren-Lawrence classification4 (range, 1 to 4); symptomatic acromioclavicular osteoarthritis; and history of shoulder fractures, glenohumeral instability, cervical radiculopathy, tumors, and frozen shoulder syndrome (<90 of passive abduction and <70 of external rotation).

External rotation in adduction improved from 23° to 51° (P = .03). The external rotation in abduction improved from 10° to 70° (P = .02). The mean Constant score improved from 39 to 62 (P = .01). The VAS for pain at rest improved from 3.3 preoperatively to 0.1 (P = .02). The VAS for ADL improved from 4.9 to 2.3 (P = .05). The transferred latissimus dorsi remained active in all cases, as reflected by increased latissimus dorsi EMG activity during abduction tasks. In addition, the latissimus dorsi EMG activity shifted from preoperative antagonistic co-activation in adduction to synergistic activation in abduction.
The authors concluded that the latissimus dorsi had synergistic muscle activity after transfer.

Comment: While the number of patients is small, this is a well done study. Patients had been treated with a rehab program for 6 months before surgery and had not responded. Patients had massive posterior superior cuff tears with grade 2 - 3 fatty infiltration with severe deficits in arm elevation and rotation. These patients were relatively young (48-67 years of age). They do a nice job of explaining the surgical technique and the aftercare.

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