Time-dependent changes after latissimus dorsi transfer: tenodesis or tendon transfer?
Background: Transfer of the latissimus dorsi tendon to the posterosuperior part of the rotator cuff is an option in active patients with massive rotator cuff tears to restore shoulder elevation and external rotation. However, it is unknown whether this treatment prevents progression of cuff tear art...
| Publicado en: | Clinical Orthopaedics & Related Research® Vol. 472; no. 12; pp. 3880 - 3889 |
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| Autores principales: | , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Dec2014
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103852554&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 103852554 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0009921X 23N jtl: Clinical Orthopaedics & Related Research® issn: 0009921X maglogo: N pubinfo: dt: Dec2014 vid: 472 iid: 12 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 103852554 NLM25002218 2012785849 10.1007/s11999-014-3770-z NLM25002218 PMC4397763 103852554 ppf: 3880 ppct: 9 formats: tig: atl: Time-dependent changes after latissimus dorsi transfer: tenodesis or tendon transfer? aug: au: Ersen, Ali Ozben, Hakan Demirhan, Mehmet Atalar, Ata Can Kapicioglu, Mehmet Erşen, Ali Kapıcıoğlu, Mehmet affil: Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey sug: subj: Rotator Cuff Surgery Shoulder Joint Surgery Muscle, Skeletal Surgery Tendon Injuries Surgery Orthopedic Surgery Methods Tenodesis Methods Aged Disease Progression Female Human Magnetic Resonance Imaging Male Middle Age Postoperative Pain Etiology Recovery Retrospective Design Rotator Cuff Injuries Rotator Cuff Physiopathology Rotator Cuff Radiography Shoulder Joint Injuries Shoulder Joint Physiopathology Shoulder Joint Radiography Shoulder Pain Etiology Muscle, Skeletal Physiopathology Muscle, Skeletal Radiography Tendon Injuries Diagnosis Tendon Injuries Physiopathology Orthopedic Surgery Adverse Effects Tenodesis Adverse Effects Time Factors Treatment Outcomes Aged: 65+ years Middle Aged: 45-64 years Female Male ab: Background: Transfer of the latissimus dorsi tendon to the posterosuperior part of the rotator cuff is an option in active patients with massive rotator cuff tears to restore shoulder elevation and external rotation. However, it is unknown whether this treatment prevents progression of cuff tear arthropathy.Questions/purposes: The purpose of this study was to determine whether the observed improvement in shoulder function in the early postoperative period with latissimus dorsi tendon transfer for irreparable rotator cuff tears will be permanent or will deteriorate in the midterm period (at 1-5 years after surgery).Methods: During a 6-year period, we performed 11 latissimus dorsi tendon transfers in 11 patients for patients with massive, irreparable, chronic tears of the posterosuperior part of the rotator cuff (defined as > 5 cm supraspinatus and infraspinatus tendon tears with Goutallier Grade 3 to 4 fatty infiltration on MRI), for patients who were younger than 65 years of age, and had high functional demands and intact subscapularis function. No patients were lost to followup; minimum followup was 12 months (median, 33 months; range, 12-62 months). The mean patient age was 55 years (median, 53 years; range, 47-65 years). Shoulder forward elevation, external rotation, and Constant-Murley and American Shoulder and Elbow Surgeons scores were assessed. Pain was assessed by a 0- to 10-point visual analog scale. Acromiohumeral distance and cuff tear arthropathy (staged according to the Hamada classification) were evaluated on radiographs.Results: Shoulder forward elevation, external rotation, Constant-Murley scores, and American Shoulder and Elbow Surgeons scores improved at 6 months. However, although shoulder motion values and Constant-Murley scores remained unchanged between the 6-month and latest evaluations, American Shoulder and Elbow Surgeons scores decreased in this period (median, 71; range, 33-88 versus median, 68; range, 33-85; p = 0.009). Visual analog scale scores improved between the preoperative and 6-month evaluations but then worsened (representing worse pain) between the 6-month and latest evaluations (median, 2; range, 0-5 versus median, 2; range, 1-6; p = 0.034), but scores at latest followup were still lower than preoperative values (median, 7; range, 4-8; p = 0.003). Although acromiohumeral distance values were increased at 6 months (median, 8 mm; range, 6-10 mm; p = 0.023), the values at latest followup (median, 8 mm; range, 5-10 mm) were no different from the preoperative ones (mean, 7 mm; range, 6-9 mm; p > 0.05). According to Hamada classification, all patients were Grade 1 both pre- and postoperatively, except one who was Grade 3 at latest followup.Conclusions: The latissimus dorsi tendon transfer may improve shoulder function in irreparable massive rotator cuff tears. However, because the tenodesis effect loses its strength with time, progression of the arthropathy should be expected over time. Nevertheless, latissimus dorsi tendon transfer may help to delay the need for reverse shoulder arthroplasty for these patients.Level Of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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