INTRODUCTION: In irreparable rotator cuff tear associated with pseudoparalysis, inverse prostheses have shown to be able to restore overhead elevation and strength. If the rotator cuff disease involves the teres minor muscle, pseudoparalysis in external rotation can adversely affect function and functional outcome of inverse arthroplasty. The goal of our study was to evaluate the outcome of inverse total shoulder arthroplasty combined with latissimus dorsi transfer for combined pseudoparalysis in elevation and external rotation.

MATERIAL AND METHODS: From 1998 till 2005, we retrospectively analyzed 11 shoulders in 10 patients with at a mean follow up of 20 months. All 11 shoulders had a massive rotator cuff tear with fatty degeneration of the posterosuperior cuff including teres minor exceeding stage 2 according to Goutallier and an average osteoarthritis grade 2 according to Samilson and Prieto Data assessment included pre- and postoperative clinical examination and Constant Score as well as standard radiographs.

RESULTS At follow up, subjective shoulder value increased from 27% to 68%, Constant Score improved significantly from 48% to 94%, flexion from 106° to 141°, abduction from 95° to 150° and strength from 0.2 to 4.9 (p< 0.05). Although no gain was seen in active external rotation in adduction, a significant loss of external lag was noted from 47° to 9° (p< 0.05). All patients were able to perform overhead activities with increase in functional use of the arm (p< 0.05). Complication requiring revision included postoperative infection in one and hematoma in another case.

CONCLUSION: Irreparable rupture of the posterosuperior rotator cuff involving with pseudoparalysis of elevation and external rotation,, the implantation of an inverse prosthesis combined with latissimus dorsi transfer can increase active range of motion and substantially improve functional external rotation, as opposed to the published results of the inverse prosthesis alone, which do not improve active external rotation.

Introduction: Structural failure of a rotator cuff repair, if associated with pain and severe dysfunction, represents a treatment challenge. Depending on the size of the retear ,the degree of fatty degeneration of the involved muscles, retraction of the musculotendinous unit, as well as age and activity level of the patient, treatment options include re-repair, re-repair with tendon transfer, glenohumeral arthrodesis and inverse total shoulder (Delta) prosthesis. The purpose of this study was to review the outcome of treatment of failed rotator cuff repairs and to compare the results of the four most important types of treatments.

Material and methods: From 1991 till 2002, we retrospectively analysed 80 patients, who underwent revision surgery of the shoulder after failed primary cuff repair. Out of them, 33 had a rerepair, 15 were treated with a delta prosthesis, 17 with a latissimus dorsi-and 15 with a pectoralis major-transfer. Data assessment included pre- and postoperative Constant Score and complication rate. Average follow-up time was 51 months.

Results: After rerepair of the rotator cuff, patients showed a significant gain in subjective shoulder value, rel. Constant Score and reduction of pain(p< 0.05), but range of motion and strength remained unchandged. After additional latissimus-dorsi-or pectoralis major-transfer no significant gain was seen in either subjective shoulder value, nor rel. Constant Score. After Implantation of delta prosthesis, significant improvement was seen in subjective shoulder value, relative Constant score, range of motion and strength (p< 0.05). These improvements were significantly better than in the other groups (p< 0.05). Complication rate was the highest in the delta group.

Conclusion: After failed rotator cuff repair, attempts of rerepair allow good subjective results by reducing pain and maintaining range of motion. Although range of motion is maintained after additional latissimus dorsi-and pectoralis major-transfer, subjective and objective results are not satisfying. After implantation of a delta prosthesis, very good subjective and objective outcome can be predicted, although results are slightly compromised by the high complication rate.