Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears: A Modified Technique to Improve Tendon Transfer Integrity

Tauber, Mark; Moursy, Mohamed; Forstner, Rosemarie; Koller, Heiko; Resch, Herbert
September 2010
Journal of Bone & Joint Surgery, American Volume;Sep2010 Supplement, p226
Academic Journal
BACKGROUND: Latissimus dorsi tendon transfer is a well-established method for the treatment of massive irreparable posterosuperior defects of the rotator cuff. Subsequent rupture of the transferred tendon may contribute to the rate of failure of the index procedure. We hypothesized that modification of our technique of tendon harvesting would lead to greater fixation stability and a reduced failure rate. METHODS: Forty-two patients (mean age, fifty-eight years) with a massive irreparable posterosuperior tear of the rotator cuff were managed with a latissimus dorsi tendon transfer. Sharp separation of the latissimus tendon from the humerus was performed in twenty-two patients (Group A), whereas the tendon harvest was carried out with a modified technique that involved removal of some bone along with the tendon at the humeral insertion in a subsequent group of twenty patients (Group B). The mean duration of follow-up was forty-seven months. Outcome measures included the Constant and American Shoulder and Elbow Surgeons (ASES) scores and a patient subjective satisfaction scale. Standard radiographs were made to determine the stage of osteoarthritis and proximal migration of the humeral head, and magnetic resonance imaging was performed to assess the integrity of the transferred muscle. RESULTS: In Group A, the mean Constant score improved from 43.4 preoperatively to 64.8 points at the time of follow-up and the mean ASES score improved from 49.3 to 69.6 points (p < 0.05). In Group B, the mean Constant score increased from 40.2 to 74.2 points and the mean ASES score, from 47.2 to 77.1 points (p < 0.05). The Constant pain score improved from 5.6 to 11.9 points in Group A and from 5.2 to 13.8 points in Group B. The results in Group B were significantly superior to those in Group A (p < 0.05). Magnetic resonance imaging revealed complete rupture at the tendon insertion with tendon retraction in four patients in Group A and none in Group B. The final outcome was rated as poor in 27% of the patients in Group A and in 10% in Group B. CONCLUSIONS: Latissimus dorsi tendon transfer achieves satisfactory clinical results in most patients who have a massive irreparable posterosuperior tear of the rotator cuff. Harvesting the tendon along with a small piece of bone enables direct bone-to-bone transosseous fixation, resulting in better tendon integrity and clinical results. LEVEL OF EVIDENCE: Therapeutic Level Ill. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Tendon transfer for irreparable rotator cuff tears: indications and surgical rationale. Merolla, Giovanni; Chillemi, Claudio; Franceschini, Vincenzo; Cerciello, Simone; Ippolito, Giorgio; Paladini, Paolo; Porcellini, Giuseppe // Muscles, Ligaments & Tendons Journal (MLTJ);2014, Vol. 4 Issue 4, p425 

    Background: treatment of symptomatic irreparable rotator cuff tears is extremely challenging because, at present, there are no ideal solutions to this problem. Many patients respond favorably to nonsurgical treatment. However, when conservative measures fail to improve the patient's pain and...

  • Latissimus dorsi transfer for treatment of irreparable rotator cuff tears. Weening, Alexander; Willems, W. // International Orthopaedics;Dec2010, Vol. 34 Issue 8, p1239 

    Massive rotator cuff tendon ruptures are not uncommon in older patients. We propose the transfer of the latissimus dorsi muscle for treatment of irreparable ruptures associated with functional impairment and chronic pain. Five women and 11 men were so treated and reviewed with an average...

  • Modified L’Episcopo Tendon Transfers for Irreparable Rotator Cuff Tears: 5-year Followup. Gerhardt, Christian; Lehmann, Lars; Lichtenberg, Sven; Magosch, Peter; Habermeyer, Peter // Clinical Orthopaedics & Related Research;Jun2010, Vol. 468 Issue 6, p1572 

    Patients with posterosuperior cuff tears lose functional external rotation of the shoulder. Latissimus dorsi and teres major transfer is performed to restore external rotation. Twenty patients with a mean age was 55.8 ± 6 years underwent this procedure and were examined at averages of 24.7 (n...

  • Humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer in patients with rotator cuff tear arthropathy and preserved subscapularis muscle function: preliminary report and short-term results. Jerosch, Joerg; Sokkar, Sherif; Neuhaeuser, Christian; Abdelkafy, Ashraf // European Journal of Orthopaedic Surgery & Traumatology;Oct2014, Vol. 24 Issue 7, p1075 

    Purpose: Humeral resurfacing arthroplasty represents an alternative option to hemiarthroplasty for treatment of cuff tear arthropathy (CTA), with the advantages as follows: suitability for relatively young and high-demand patients because of preservation of bone stock and no loss of length, less...

  • The rotator cuff muscles are activated at low levels during shoulder adduction: an experimental study. Reed, Darren; Halaki, Mark; Ginn, Karen // Journal of Physiotherapy (Australian Physiotherapy Association);2010, Vol. 56 Issue 4, p259 

    Question: During isometric shoulder adduction in normal subjects, do the rotator cuff muscles activate more than other shoulder muscles? Are the activation patterns influenced by shoulder abduction angle or load? Design: A within-participant, repeated measures experimental study. Participants:...

  • shoulder to shoulder. Cole, Roger // Yoga Journal;Dec2009, Issue 225, p85 

    The article explores on the exercise on how to loosen the latissimus dorsi muscles to improve one's range of motion in each yoga session. It notes that if the latissimus muscle is too tight, it will limit one's ability to rotate externally the arm resulting in rotator cuff injury. Several yoga...

  • Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. Zafra, Manuel; Carpintero, Pedro; Carrasco, Carmen // International Orthopaedics;Apr2009, Vol. 33 Issue 2, p457 

    The objective of this paper was to determine the outcome of the transfer of the latissimus dorsi tendon in patients with massive irreparable rotator cuff tears. Eighteen patients of mean age 54 years (range 37-72 years) with massive irreparable rotator cuff tears were studied. The mean follow-up...

  • Latissimus Dorsi Tendon Transfer for Treatment of Irreparable Posterosuperior Rotator Cuff Tears. Gerber, Christian; Rahm, Stefan A.; Catanzaro, Sabrina; Farshad, Mazda; Moor, Beat K. // Journal of Bone & Joint Surgery, American Volume;11/6/2013, Vol. 95-A Issue 21, p1920 

    Background: Transfer of the latissimus dorsi tendon to the greater tuberosity of the humerus for treatment of an irreparable rotator cuff tear has been reported to yield good-to-excellent short to intermediate-term results in well-selected patients. The purpose of this study was to evaluate the...

  • Time-dependent Changes After Latissimus Dorsi Transfer: Tenodesis or Tendon Transfer? Erşen, Ali; Ozben, Hakan; Demirhan, Mehmet; Atalar, Ata; Kapıcıoğlu, Mehmet // Clinical Orthopaedics & Related Research;Dec2014, Vol. 472 Issue 12, p3880 

    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...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics