Results of Latissimus Dorsi Transfer using a Tendinous Allograft through a Single Deltopectoral Approach for Irreparable Posterosuperior Rotator Cuff Tears

Miyazaki, Alberto Naoki; Checchia, Caio Santos; Fonseca Filho, João Manoel; Rosa, João Roberto Polydoro; Sella, Guilherme do Val; Silva, Luciana Andrade da

doi:10.1055/s-0041-1724073

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Original Article • Rev. bras. ortop. 57 (04) • Jul-Aug 2022 • https://doi.org/10.1055/s-0041-1724073 copy

Results of Latissimus Dorsi Transfer using a Tendinous Allograft through a Single Deltopectoral Approach for Irreparable Posterosuperior Rotator Cuff Tears

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The primary aim of the present study is to evaluate the functional results of a modification to the latissimus dorsi (LD) transfer around the shoulder for irreparable posterosuperior rotator cuff tears. The secondary aim is to evaluate variables that might influence the outcomes.

Surgical Technique

Through a single deltopectoral approach, the LD tendon is detached, reinforced, and elongated with a tendinous allograft, transferred around the humerus, and fixed superolaterally to the greater tuberosity and anteriorly to the subscapularis.

Methods

Retrospective functional evaluation of 16 cases. The average follow-up was 21 months (12-47). The postoperative results (at last follow-up) were compared with the preoperative ones, as well as to other pre, intra, and postoperative variables.

Results

All (but one) patients were satisfied. Average University of California, Los Angeles (UCLA) score increased from 11.6 (8-16) to 27.3 (17-30) (p< 0.001). Improvements of shoulder pain, function, and strength achieved statistical significance (p< 0.001). Nonetheless, normal strength was never restored. Average active range of motion improved as follows: forward elevation, from 106° (60-140°) to 145° (130-160°) (p< 0.001); external rotation from 30° (0° to 60°) to 54° (40-70°) (p< 0.001); and internal rotation from L1 (gluteus to T7) to T10 (T12-T3) (p< 0.05). No complication has occurred. Preoperative pseudoparesis was reverted in all the six cases in which it was present. None of the variables analyzed influenced the outcomes, including pseudoparesis.

Conclusions

At early follow-up, this technique is safe and effective at recovering from pseudoparesis and at improving shoulder pain, function, and strength.

Keywords
rotator cuff injuries; tendon transfer; shoulder; orthopedic procedures

						Goutallier
Case #	Gender	Age	Dominance	Trauma?	Symptoms (in months)	SUPRA	INFRA	SUBSCAP	HAMADA	Graft	Follow-up (in months)
1	M	77	+	-	36	3	3	1	1	Patellar	13
2	M	56	-	-	24	2	3	1	2	Fascia Lata	13
3	M	61	-	+	25	3	4	0	2	Patellar	21
4	F	52	+	+	10	3	4	1	1	Patellar	31
5	F	63	+	+	24	4	4	0	1	Patellar	43
6	F	68	+	-	36	4	4	4	1	Fascia Lata	12
7	F	64	+	-	96	4	4	4	3	Patellar	47
8	F	68	+	+	52	2	2	2	4B	Quadricipital	19
9	M	68	+	+	7	3	3	0	1	Fascia Lata	15
10	F	59	+	-	17	2	3	0	1	Fascia Lata	15
11	F	67	+	-	36	3	3	1	2	Fascia Lata	16
12	F	56	+	-	24	4	4	0	1	Fascia Lata	14
13	F	61	+	+	23	3	3	2	1	Patellar	28
14	F	82	+	+	24	4	4	2	1	Patellar	19
15	M	67	-	+	7	3	3	1	1	Fascia Lata	12
16	M	67	+	+	72	3	3	1	1	Fascia Lata	15
AVERAGE		65			32						21

Case #	ROM						UCLA
Case #	FLEX PRE	FLEX POST	EXT ROT PRE	EXT ROT POST	INT ROT PRE	INT ROT POST	PAIN PRE	PAIN POST	FUNCTION PRE	FUNCTION POST	FLEX PRE	FLEX POST	STRENGTH PRE	STRENGTH POST	SATISF PRE	SATISF POST	TOTAL PRE	TOTAL POST
1	70	160	45	70	Gluteus	T12	4	8	4	8	3	5	3	3	0	5	14	29
2	70	150	0	45	Gluteus	T3	2	8	2	8	2	5	2	3	0	5	8	29
3	120	160	0	50	T9	T5	6	8	2	4	3	4	2	3	0	5	13	24
4	140	150	50	60	T10	T12	2	6	2	6	4	5	3	4	0	5	11	26
5	120	160	40	45	T10	T8	4	8	4	8	4	5	3	4	0	5	15	30
6	120	140	45	45	T12	L1	4	8	4	6	4	4	3	3	0	5	15	27
7	70	160	45	60	T12	T10	1	5	4	8	2	5	2	3	0	5	9	26
8	130	140	30	60	Gluteus	T7	2	8	2	8	4	5	3	4	0	5	11	30
9	120	140	20	50	T12	T12	1	10	1	8	3	3	2	4	0	5	7	30
10	80	160	60	60	T12	T12	4	8	2	8	1	5	2	4	0	5	9	30
11	130	130	45	45	T10	T10	2	2	8	8	3	3	3	4	0	0	16	17
12	140	140	50	60	T7	T7	2	10	8	8	3	3	3	4	0	5	16	30
13	125	140	30	70	T9	T10	2	10	4	8	3	5	2	4	0	5	11	29
14	90	130	0	60	L5	T12	4	6	2	6	1	3	1	3	0	5	8	23
15	100	130	20	40	T12	T9	4	8	4	8	3	4	2	4	0	5	13	29
16	70	130	0	40	Gluteus	T12	4	8	2	8	1	4	3	4	0	5	10	29
AVERAGE	105.94	145	30	53.75	L1	T10	3.00	7.56	3.44	7.38	2.75	4.25	2.44	3.63	0.00	4.69	11.63	27.38
p	< 0.001		< 0.001				< 0.001		< 0.001		< 0.001		< 0.001		< 0.001		< 0.001

Average gain of	PSEUDOPARETIC (6 cases)	NONPSEUDOPARETIC (10 cases)	p
ROM - FLEX	73.33°	18.5°	< 0.001 ***
ROM - EXT ROT	30.83°	19.5°	0.27
ROM - INT ROT	6.17°	1.7°	0.09
UCLA - PAIN	4	4.9	0.48
UCLA - FUNCTION	5	3.3	0.12
UCLA - FLEX	2.83	0.7	< 0.001 ***
UCLA - STRENGTH	1.17	1.2	0.925
UCLA - SATISF	5	4.5	0.458
UCLA - TOTAL	18	14.4	0.183
ROM - FLEX PREOP	75°	124.5°	< 0.001 ***
ROM - FLEX POSTOP	148.33°	143°	0.41

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Caio Santos Checchia, Grupo de Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, Rua Dr. Cesario Mota Junior, 112, Consolação, São Paulo, SP, 01221-020, Brazil (e-mail: caio.checchia@gmail.com).