Comparison of arthroscopically assisted transfer of the latissimus dorsi with or without partial cuff repair for irreparable postero-superior rotator cuff tear

摘要

PurposeTo evaluate the effect of an additional partial repair in combination with an arthroscopically assisted transfer of the latissimus dorsi (LDT) in massive postero-superior irreparable cuff tear.Materials and methodsThirty-one patients (mean age 59.2years) scheduled for arthroscopically assisted LDT either isolated or in combination with a partial cuff repair for a massive posterior-superior cuff tear were prospectively included between January 2011 and December 2013 at our institution. Seventeen had an isolated transfer (Group A) and 14 had a transfer combined with a partial cuff repair (Group B). Outcome measures included visual analogue scale (VAS), range of motion, strength, constant score, and subjective shoulder value (SSV). Potential predictive factors were analyzed.ResultsAt the last follow-up (mean 22months), patients in Group B had a significantly higher constant score (648 versus 584 in Group A), range of motion (33 +/- 5 versus 29 +/- 5 points in Group A), and strength at 90 degrees of abduction (2.5kg +/- 1 in Group B versus 1.9kg +/- 0.9 in Group A). No significant differences were found between both groups regarding pain scores, SSV, and active external rotation. Thirty-seven variables were analyzed and the only factor which was found to be predictive of a bad result was a preoperative SSV<40 pts. (RR 0.5).ConclusionArthroscopically assisted LDT gives better results when combined with a partial repair of the cuff than when it is performed isolated in the treatment of massive irreparable postero-superior rotator cuff tear.Level of evidence: Treatment study, Level II