Article

Are there advantages of the combined latissimus-dorsi transfer according to L'Episcopo compared to the isolated latissimus-dorsi transfer according to Herzberg after a mean follow-up of 6 years? A matched-pair analysis

ATOS-Klinik Heidelberg, Heidelberg, Germany. Electronic address: .
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] (Impact Factor: 2.37). 04/2012; 21(11):1499-507. DOI: 10.1016/j.jse.2012.01.002
Source: PubMed

ABSTRACT The aim of the study was to evaluate differences of clinical results between the latissimus-dorsi transfer combined with teres-major transfer (G1) and the isolated latissimus-dorsi transfer (G2) for the treatment of massive irreparable postero-superior rotator cuff tears.
We performed the combined latissimus-dorsi/teres-major transfer in 17 patients at a mean age of 57 years. Furthermore, 17 patients at a mean age of 61 years were treated using the isolated latissimus-dorsi transfer. Both groups were followed-up clinically, radiologically, and with surface electromyography using the same study protocol.
The Constant score (CS) improved significantly from 48.3 points pre-op to 69.5 points post-op after a follow-up of 58 months in G1. The active range of motion improved in G1 sig. for flexion (124° pre-op, 166.5° post-op) and for abduction (117° pre-op, 163° post-op). The CS improved significantly from 45.1 points pre-op to 74.2 points post-op after a follow-up of 51 months in G2. The flexion and abduction increased significantly from 133.3° pre-op to 176° post-op, resp. from 113.3° pre-op to 173° post-op. The comparison of both surgical techniques showed a significant better active flexion and abduction for G2.
Both techniques achieved good functional results but the isolated latissimus-dorsi transfer produced a better active abduction and flexion, whereas the combined latissmus-dorsi/teres-major transfer achieved an increase in abduction strength. In contrast to the combined latissimus-dorsi/teres-major transfer, a progression of cuff tear arthropathy was not observed with the isolated latissimus-dorsi transfer.

1 Follower
 · 
164 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hypothesis The purpose of this study is to evaluate the muscle activity with surface electromyography (EMG) and the clinical outcome of the latissimus dorsi transfer. It remains unclear whether the clinical results of the latissimus dorsi transfer for massive posterosuperior rotator cuff tears are achieved either by active muscle contractions or by a passive tenodesis effect of the transfer. Methods Eight patients were evaluated preoperatively and at 1 year (SD, 0.1) after the latissimus dorsi transfer. Clinical evaluation of outcomes included active range of motion, Constant score, and visual analog scale (VAS) for pain and activities of daily living (ADL). Muscle activity was recorded with EMG during directional isometric abduction and adduction tasks. Results The external rotation in adduction improved from 23° to 51° (p = 0.03). The external rotation in abduction improved from 10° to 70° (p = 0.02). The mean Constant score improved from 39 to 62 postoperatively (p = 0.01). The VAS for pain at rest improved from 3.3 preoperatively to 0.1 (p = 0.02). The VAS for ADL improved from 4.9 to 2.3 (p = 0.05). 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. Conclusion The latissimus dorsi has synergistic muscle activity after transfer. Apart from a tenodesis effect, directional muscle activity seems relevant for improved clinical outcome and pain relief. A specific gain was observed for external rotation in elevated arm positions, a motion essential for ADL tasks.
    Journal of Shoulder and Elbow Surgery 10/2013; DOI:10.1016/j.jse.2013.07.055 · 2.37 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Latissimus dorsi tendon transfer is a method for surgical treatment of massive irreparable posterosuperior cuff tears. It partially restores active anteflexion, external rotation, and function of the shoulder but does not significantly increase strength of the shoulder. It is contraindicated in case of pseudoparalytic shoulder; associated irreparable subscapularis tear, deltoid palsy, and in case of associated osteoarthritis, as an isolated procedure. Results are inferior when performed as a secondary procedure compared with a primary procedure. However, latissimus dorsi tendon transfer is an attractive solution to improve shoulder mobility and function of young and non osteoarthritic patients whose previous surgical treatment of massive postero-superior irreparable rotator cuff tear failed. As a primary procedure, latissimus dorsi tendon transfer competes with debridement, biceps tenotomy, and partial cuff repair. In association with reverse shoulder arthroplasty, it restores active external rotation in osteoarthritic patients with active external rotation deficit. New arthroscopic assisted techniques might improve results in the future.
    Current Reviews in Musculoskeletal Medicine 01/2014; 7(1). DOI:10.1007/s12178-013-9196-5
  • [Show abstract] [Hide abstract]
    ABSTRACT: Sehnentransferoperationen wurden in den letzten Jahrzehnten für den jüngeren Patienten mit nichtrekonstruierbarer Rotatorenmanschettenläsion etabliert.Indikation, prädiktive Faktoren und klinische Ergebnisse von Sehnentransferoperationen in der Rotatorenmanschettenchirurgie sowie mögliche Technik-Modifikationen sollen besprochen werden.Aktuelle Literatur und Grundlagenarbeiten sowie Expertenempfehlungen werden ausgewertet und im Zusammenhang mit eigenen Fällen diskutiert.In den letzten Jahren konnten für den M.-latissimus-dorsi-Transfer für posterosuperiore Defekte sowie den M.-pectoralis-major-Transfer für anteriore Defekte eine Vielzahl von prädiktiven, bei der Indikationsstellung zu beachtenden Faktoren herausgearbeitet werden. Da die Indikation im Zeitintervall zwischen noch rekonstruierbarer Ruptur und fortgeschrittener Defektarthropathie jedoch sehr eng gestellt werden muss, sind die Fallzahlen limitiert. Die klinischen Ergebnisse aktueller Fallserien zeigen bei exakter Indikationsstellung im Durchschnitt eine signifikante Funktionsverbesserung der Schulter, jedoch keine komplette Wiederherstellung der Schulterfunktion. In der Literatur liegen größere Fallserien des M.-latissimus-dorsi-Transfers vor. Mit dieser Technik werden postoperativ bessere funktionelle Ergebnisse erzielt.Zusammenfassend bietet der Muskeltransfer im Zeitintervall zwischen noch rekonstruierbarer Ruptur und fortgeschrittener Defektarthropathie eine zusätzliche therapeutische Option, die klinischen Ergebnisse sind jedoch stark von der korrekten Indikationsstellung abhängig.
    Arthroskopie 02/2014; 27(1). DOI:10.1007/s00142-013-0770-z
Show more