Surgical Management of Massive Irreparable Cuff Tears: Latissimus Dorsi Transfer for Posterosuperior Tears
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SURGICAL MANAGEMENT OF MASSIVE IRREPARABLE CUFF TEARS (J SANCHEZ-SOTELO, SECTION EDITOR)
Surgical Management of Massive Irreparable Cuff Tears: Latissimus Dorsi Transfer for Posterosuperior Tears Karl Wieser 1 & Lukas Ernstbrunner 1 & Matthias A. Zumstein 2,3
# The Author(s) 2020
Abstract Purpose of Review This review aims to describe the role of the latissimus dorsi transfer (LDT) for patients with irreparable posterosuperior rotator cuff tears (RCTs). Recent Findings Historically, the LDT has been performed as an open (double-incision) procedure for neurologically intact, relatively young patients with irreparable posterosuperior RCTs with disabling loss of active external rotation with or without impaired active elevation. The transferred tendon reconstitutes the posterior rotator cuff and force couple, respectively and thus has the potential to function effectively as an external rotator and humeral head depressor. Long-term results of the open technique have demonstrated in the majority of patients substantial and durable improvements in shoulder function and pain relief at the 10-year benchmark. With the advancements of arthroscopic surgery, the LDT was expanded to an arthroscopically assisted procedure with promising short-term results. In addition to adequate technical performance, the success of the procedure depends on preoperative factors, such as exclusion of glenohumeral osteoarthritis and acromial acetabularization; intact or reparable subscapularis tendon; intact (or hypertrophic) teres minor muscle; adequate preoperative activity of the latissimus dorsi; and normal or mild impairment of overhead function. Summary The LDT (open or arthroscopically assisted) is a reliable treatment option for patients with massive, irreparable posterosuperior RCTs with disabling loss of active external rotation, with or without diminished overhead function and without advanced glenohumeral osteoarthritis. Precise patient selection is of tremendous importance in the success of the LDT. Keywords Latissimus dorsi transfer . Tendon transfer . Arthroscopically assisted . Massive rotator cuff tear . Posterosuperior rotator cuff
Introduction This article is part of the Topical Collection on Surgical Management of Massive Irreparable Cuff Tears * Karl Wieser [email protected] Lukas Ernstbrunner [email protected] Matthias A. Zumstein [email protected] 1
Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340 CH-8008 Zurich Switzerland
2
Shoulder, Elbow & Orthopaedic Sports Medicine, Orthopaedics Sonnenhof; Inselspital, University of Berne, Bern Switzerland
3
SportsClinicNumber1, Bern Switzerland
The generated forces of co-contracting rotator cuff muscles stabilize the humeral head within the glenoid concavity providing a stable fulcrum for optimal force transmission of the deltoid, rotator cuff, and periscapular muscles. Rupture of the rotator cuff tendons is common and might cause disruption of this delicately balanced force couple of anterior (subscapularis
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