2015 ISAKOS Biennial Congress ePoster #2428
Arthroscopic Latissimus Dorsi Transfer for Irreparable Posterosuperior Rotator Cuff Tear. Does it Restore Active External Rotation?
Jose Silberberg, MD, PhD, Madrid, Madrid SPAIN
Gilles Walch, MD, Lyon FRANCE
Jose-Ramón Muiña Rullan, MD, Madrid, Madrid SPAIN
Martín Alejandro Giménez, MD, Villa Del Rosario, Entre Ríos ARGENTINA
Gianezio Paribelli ITALY
IMDOR - Hospital NIsa Pardo de Aravaca, Madrid, Madrid, SPAIN
FDA Status Not Applicable
Summary: One of the factors that could influence clinical outcome after LDTT in masive rotator cuff tears is the teres minor status: in our study, fatty infiltration, equal or grater than 2, showed to be significantly less favourable than shoulders with healthier teres minor in terms of active external rotation in abbduction.
Clinical outcomes–mid to long term follow-up after a LDTT have been reported in the literature, however there is scarce data on factors that may influence prognosis.
To perform a comparative analysis of final results after arthroscopic LDTT (Paribelli Technique) as a primary procedure in patients with irreparable rotator cuff tears, with and without teres minor fatty infiltration.
We hypothesize that after LDTT procedure, patients with teres minor fatty infiltration could restore but not improve active external rotation of the shouler.
Seventeen consecutive patients who underwent LDTT assisted by arthroscopy (Paribelli procedure) for massive irreparable posterosuperior rotator cuff tears were prospectively reviewed clinically and radiographically.
Patients were divided into two groups in relation to teres minor status: fatty infiltration according to the Goutallier Classification. Group I: stage 0 - 2 of fatty infiltration, and Group II associated to greater than stage 2. Mean follow-up was 28 months (range, 18-44).
None patients presented subscapularis tear, gleno-humeral (GH) osteoarthritis, shoulder stiffness or previous surgeries. Active range of motion included external rotation in adduction-abduction and Constant modified score. Radiological evaluation: postoperative MR images to evaluate the presence and the integration of the tendon transferred to the greater tuberosity were observed.
Following LDTT, patients of both groups except one would have the same surgery again. Constant score significantly improved in both groups: Group I from 51 to 66,33 while in Group II from 48,25 to 60,75 (range, 57-65).
Patients improved significantly in terms of flexion, abduction, external rotation in adduction and abduction, as well as in strength.
Differences between preoperative and postoperative active external rotation were significant within each group (p< .05) and between both groups. (p< .001). AER in adduction: Group I from 29,44 to 50,56; Group II from 10 to 28,13. AER in 90º abduction: Group I: from 26,11 to 52,22; Group II: from 13,73 to 21,25.
Strength evaluation: AER in adduction assessment. Group I: from 2,88 to 4,8; Group II: from 1,75 to 3,25. AER in 90º abduction: Group I: from 2,33 to 3,22 and in Group II: From 1 to 1.
MR images did not allowed to confirm the integrity of the LDTT in 5 cases of 17 patients at the final follow-up but pain relief and maintenance in function were almost the same along the study. Included theses particular cases.
Latissimus dorsi tendon transfer is a useful surgical procedure for active patients who present an irreparable posterosuperior rotator cuff tear. It improves active forward elevation and abduction of the shoulder, however, it allow to maintain but not improve the active external rotation in 90º of abduction in those cases with a presence of fatty infiltration of the teres minor greater than stage 2 in the preoperative images.