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High Clinical Failure Rate After Latissimus Dorsi Transfer for Revision Massive Rotator Cuff Tears.
- Source :
-
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association [Arthroscopy] 2020 Jan; Vol. 36 (1), pp. 88-94. - Publication Year :
- 2020
-
Abstract
- Purpose: To evaluate the clinical success rate, along with risk factors for failure, in patients undergoing latissimus dorsi transfer for the treatment of massive, irreparable, previously failed rotator cuff tears.<br />Methods: We performed a retrospective chart review of prospectively collected data from an institutional shoulder outcome registry. All patients who underwent latissimus dorsi transfer for previously failed rotator cuff repair between 2006 and 2013 with a minimum follow-up period of 1 year were included in the study. The indications for inclusion were large (≥2 tendons), retracted, chronic rotator cuff tears with fatty infiltration or atrophy for which prior surgical repair had failed. Preoperative and postoperative American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test scores were collected, along with postoperative Single Assessment Numerical Evaluation scores. Complications and clinical failures (Δ in ASES score <17) were recorded. Patient demographic and tear characteristics were evaluated as potential risk factors for failure.<br />Results: A total of 22 patients (mean age, 53 ± 6 years) were included in the study, with a mean follow-up time of 3.4 ± 1.1 years. Over 63% of patients (n = 14) reported undergoing 2 or more prior failed rotator cuff repairs. Patients undergoing latissimus dorsi transfer showed significant improvements in ASES scores (from 35.2 ± 21.9 preoperatively to 55.8 ± 22.9 postoperatively, P = .001), Simple Shoulder Test scores (from 3.5 ± 3.1 preoperatively to 5.2 ± 3.4 postoperatively, P = .002), and pain scores (from 5.9 ± 2.8 preoperatively to 4.6 ± 4.3 postoperatively, P = .002) at final follow-up. The complication rate after latissimus transfer was 27%. The rate of revision to reverse total shoulder arthroplasty was 13.6% (n = 3) after a mean of 2.7 years, and the clinical failure rate was 41% (n = 9) at final follow-up. An acromiohumeral interval of less than 7 mm (P = .04) and high-grade fatty infiltration (grade 3 or greater, P = .004) were significant preoperative risk factors for clinical failure.<br />Conclusions: Latissimus dorsi tendon transfer resulted in a clinical failure rate of 41% and complication rate of 27%, with an acromiohumeral interval of less than 7 mm and high-grade fatty infiltration being associated with postoperative failure.<br />Level of Evidence: Level IV.<br /> (Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Postoperative Period
Retrospective Studies
Rotator Cuff diagnostic imaging
Rotator Cuff Injuries diagnosis
Rupture
Shoulder Joint diagnostic imaging
Superficial Back Muscles diagnostic imaging
Treatment Outcome
Rotator Cuff surgery
Rotator Cuff Injuries surgery
Shoulder Joint surgery
Superficial Back Muscles surgery
Tendon Transfer methods
Tendons surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1526-3231
- Volume :
- 36
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
- Publication Type :
- Academic Journal
- Accession number :
- 31864605
- Full Text :
- https://doi.org/10.1016/j.arthro.2019.07.034