Latissimus dorsi muscle transfer reduces external rotation deficit at the cost of internal rotation in reverse shoulder arthroplasty patients: a cohort study
These authors reviewed 26 patients with cuff tear arthropathy and a positive lag sign with maximum external rotation of zero degrees having a reverse total shoulder (RSA).
These authors reviewed 26 patients with cuff tear arthropathy and a positive lag sign with maximum external rotation of zero degrees having a reverse total shoulder (RSA).
26 RCA patients with a deficit in active external rotation (ERD) (ie, positive lag sign and maximum active ER of 0°) Latissimus dorsi transfer (LDT) was carried out in 13 of these patients.
In addition, 88 control patients without external rotation deficits who underwent only RSA were identified.
The LDT procedure extended the surgical time by 26 minutes (P = .003). LDT patients had up to 22° better postoperative active ER than control patients (P < .001), although this was accompanied by an internal rotation deficit (77% vs 46% of control patients could not reach the lumbosacral region, P = .010).
They calculated a 23% risk of local procedure–related complications for RSA patients with an active ERD and LDT.
The LDT procedure extended the surgical time by 26 minutes (P = .003). LDT patients had up to 22° better postoperative active ER than control patients (P < .001), although this was accompanied by an internal rotation deficit (77% vs 46% of control patients could not reach the lumbosacral region, P = .010).
They calculated a 23% risk of local procedure–related complications for RSA patients with an active ERD and LDT.
The clinical outcomes are shown here, with a slight drop off in the quality of the result for the LDT group at longer term followup.
Comment: This article does a nice job of pointing out the challenges involved in using an LDT in an attempt to improve active external rotation.
It is worthwhile pointing out that with reverse total shoulders that medicalize the center of rotation, a reverse may actually slacken / weaken the external rotators, as shown in diagram B below by Steve Lippitt. Diagram C shows that lateralizing the center of rotation may help keep the external rotators under tension.
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How you can support progress in shoulder surgery
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How you can support progress in shoulder surgery
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
