CORR Insights^®: Time-dependent Changes After Latissimus Dorsi Transfer: Tenodesis or Tendon Transfer?

Excerpt

The management of massive irreparable rotator cuff tears in young active patients remains a challenge. Reverse total shoulder arthroplasty has demonstrated reliable improvements in both pain and function in more elderly or less active patients, but its use in younger patients is controversial. Transfer of the latissimus dorsi tendon to the greater tuberosity in the fashion of L’Episcopo [9] for this problem was first proposed by Gerber [4] and multiple series have been published through the years with generally good results [1, 5, 11] with respect to improvements both in pain and function. Electromyogram and nerve conduction studies reveal dynamic functioning of the transferred muscle in both forward elevation and external rotation [6, 8]. Because of the rarity of this problem, most studies contain relatively few patients and most of the world’s published experience derives from just a few centers. Although most patients have benefitted from this procedure, mixed results have been reported [7, 13] and only some prognostic indicators have been identified to help guide treatment recommendations. It is generally accepted that an intact subscapularis tendon is required for this tendon transfer to be successful [5]. Other factors that may influence results include fatty infiltration of the teres minor [3], gender [2], and revision status [10, 14, 15]. Confusion remains as to the identification of the ideal patient for this relatively extensive procedure. When is a patient better suited for partial repair of these massive rotator cuff tears, a procedure associated with much less morbidity? This procedure is not indicated in cases of anterosuperior escape and its use in patients who cannot elevate to shoulder level may not be as beneficial as it is in those patients who demonstrate active elevation above the horizontal preoperatively. Despite a recent systematic review [12], the ideal patient for this procedure is not clearly defined primarily because of the relatively small number of patients in the literature. …