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Latissimus Dorsi Tendon Transfer Vs. Superior Capsular Reconstruction for Treatment of Irreparable Massive Rotator Cuff Tears: A Retrospective Comparison Study with Short-Term Clinical Results
ESSKA Academy. de SA D. 05/09/18; 209948; P22-1897 Topic: Shoulder
Dr. Darren de SA
Dr. Darren de SA
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Objectives: Repairs of massive posterosuperior rotator cuff tears have been associated with poorer outcomes and higher failure rates compared with isolated repairs of small supraspinatus tears. Irreparable massive rotator cuff tears, particularly those that occur in younger patients, represent a particularly challenging clinical scenario. Options are limited and treatments such as reverse total shoulder arthroplasty are not well indicated for this patient population. We compared two treatment methods, latissimus dorsi tendon transfer (LDTT) vs arthroscopic superior capsular reconstruction (SCR), to determine if one was superior in restoring range of motion and improving pain for patients with this challenging problem. We hypothesize that both treatments would have similar outcomes regarding functional restoration and pain relief.

Methods: A retrospective cohort study assessed 19 patients with an irreparable posterosuperior rotator cuff tear after failed conservative or surgical treatment who underwent either LDTT (12 patients, 14 shoulders) or SCR (7 patients, 7 shoulders). Patients with a minimum of 6 month follow-up were included (mean follow up: 19 months, 8.6 months respectively). VAS pain scale and preoperative and postoperative forward flexion and external rotation were evaluated. T-test and Mann- Whitney U statistical tests were performed. Complications were also assessed.

Results: The mean age for LDTT or SCR at the time of surgery was 60.5 vs 55.2 years respectively. Both cohorts demonstrated similar improvement in forward flexion with mean active forward flexion improving from 128° (90-160°) pre-operatively to 142° (90-180°) postoperatively in the LDTT group and 118° (40-160°) preoperatively to 141° (40-175°) postoperatively in the SCR group (p =0.50). Greater improvement in external rotation was seen in the LDTT group with mean active external rotation from 42° (10-55°) preoperatively to 61° (10-80°) post-operatively compared with the SCR group which demonstrated improvement from 38° (20-60°) preoperatively to 40.8° (20-60°) postoperatively (p =0.02). At final follow up, better pain relief was experienced in the SCR patients with 100% reporting no pain compared to the LDTT group with 35% patients reporting no pain, 57% mild pain, and 8% moderate pain (p<0.05). Two major complications occurred in the LDTT group including deep infection requiring surgical treatment and one rupture of the latissimus transfer. No major complications occurred in the SCR group.

Conclusions: LDTT and SCR both effectively improve forward flexion in patients with irreparable posterosuperior rotator cuff tears with greater improvement in external rotation in LDTT patients and greater pain improvement in SCR patients at short term follow-up. Longer term outcomes are necessary prior to commenting on the superiority of one technique over the other or establishing appropriate indications for management of this challenging scenario.

Keywords:
rotator cuff, superior capsular reconstruction, latissimus dorsi, irrepairable
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