LATISSIMUS DORSI TRANSFER FOR POSTEROSUPERIOR ROTATOR CUFF TEARS: TWO-YEAR RESULTS

Abstract

Purpose of the study: Latissimus dorsi transfer is proposed for irreparable superior and posterior rotator cuff tears, particularly in the effect of deficient active external rotation. The purpose of this study was to analyzed outcome at minimum two years follow-up.

Material and methods: Between 2001 and 2002, eleven patients underwent latissimus dorsi transfer for an irreparable tear of the supraspinatus and infraspinatus. Surgery was proposed because of the patient’s young age and occupational activity level, or because of a disabling deficit of active external rotation. There were six men and five women, mean age 52.5 years (range 36–66 years). There were seven right shoulders and nine dominant shoulders. Symptom onset was progressive in seven with a mean duration of 33 months (range 2–144 months). Active external rotation was measured at −14° to 29° in five patients with a positive dropping test. Three patients presented pseudoparalysis. The preoperative Constant score was 52±12 points. Preoperative the subacromial space measured less than 6 mm in all patients. Muscle degeneration of the infraspinatus was noted grade 2 or greater (Goutallier).

Results: Mean follow-up was 26 months (range 24–36). Subjective outcome was very satisfactory for eight patients, satisfactory for one and disappointing for two. Seven of nine patients resumed their occupational activity. The postoperative Constant score was 73±10 points. None of the patients presented pseudoparalysis at review. Pain was improved in all. Active external rotation was significantly improved in six. Postoperative, the dropping test persisted in two patients. The subacromial space was still 6 mm. Better results were obtained when active deficit was predominant than when anterior elevation (pseudoparalytic shoulder) or external rotation (positive dropping test) were predominant.

Discussion and conclusion: Latissimus dorsi transfer provides a solution for irreparable superior and posterior rotator cuff tears. The pain relief is significant. Active external rotation is improved. This is an interesting alternative in young patients or when the motor deficit is a severe handicap.