Resultados da transferência do grande dorsal alongado com enxerto tendíneo homólogo por via delto-peitoral para lesões póstero-superiores irreparáveis do manguito rotador

Alberto Naoki Miyazaki; Caio Santos Checchia; João Manoel Fonseca Filho; João Roberto Polydoro Rosa; Guilherme do Val Sella; Luciana Andrade da Silva

doi:10.1055/s-0041-1724073

Revista Brasileira de Ortopedia, Table of Contents

CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(04): 590-598
DOI: 10.1055/s-0041-1724073

Artigo Original

Ombro e Cotovelo

Results of Latissimus Dorsi Transfer using a Tendinous Allograft through a Single Deltopectoral Approach for Irreparable Posterosuperior Rotator Cuff Tears

Article in several languages: português | English

Alberto Naoki Miyazaki

¹Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil

,

Caio Santos Checchia

¹Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil

,

João Manoel Fonseca Filho

¹Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil

²Departamento de Cirurgia Ortopédica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil

,

João Roberto Polydoro Rosa

¹Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil

²Departamento de Cirurgia Ortopédica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil

,

Guilherme do Val Sella

¹Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil

,

Luciana Andrade da Silva

¹Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil

› Author Affiliations

Abstract

Objective The primary aim of the present study is to evaluate the functional results of a modification to the latissimus dorsi (LD) transfer around the shoulder for irreparable posterosuperior rotator cuff tears. The secondary aim is to evaluate variables that might influence the outcomes.

Surgical Technique Through a single deltopectoral approach, the LD tendon is detached, reinforced, and elongated with a tendinous allograft, transferred around the humerus, and fixed superolaterally to the greater tuberosity and anteriorly to the subscapularis.

Methods Retrospective functional evaluation of 16 cases. The average follow-up was 21 months (12–47). The postoperative results (at last follow-up) were compared with the preoperative ones, as well as to other pre, intra, and postoperative variables.

Results All (but one) patients were satisfied. Average University of California, Los Angeles (UCLA) score increased from 11.6 (8–16) to 27.3 (17–30) (p < 0.001). Improvements of shoulder pain, function, and strength achieved statistical significance (p < 0.001). Nonetheless, normal strength was never restored. Average active range of motion improved as follows: forward elevation, from 106° (60–140°) to 145° (130–160°) (p < 0.001); external rotation from 30° (0° to 60°) to 54° (40–70°) (p < 0.001); and internal rotation from L1 (gluteus to T7) to T10 (T12–T3) (p < 0.05). No complication has occurred. Preoperative pseudoparesis was reverted in all the six cases in which it was present. None of the variables analyzed influenced the outcomes, including pseudoparesis.

Conclusions At early follow-up, this technique is safe and effective at recovering from pseudoparesis and at improving shoulder pain, function, and strength.

Keywords

rotator cuff injuries - tendon transfer - shoulder - orthopedic procedures

Full Text

References

Referências
1 Gerber C. Latissimus dorsi transfer for the treatment of irreparable tears of the rotator cuff. Clin Orthop Relat Res 1992; (275) 152-160
2 El-Azab HM, Rott O, Irlenbusch U. Long-term follow-up after latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears. J Bone Joint Surg Am 2015; 97 (06) 462-469
3 Mulieri P, Dunning P, Klein S, Pupello D, Frankle M. Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. J Bone Joint Surg Am 2010; 92 (15) 2544-2556
4 Gerber C, Canonica S, Catanzaro S, Ernstbrunner L. Longitudinal observational study of reverse total shoulder arthroplasty for irreparable rotator cuff dysfunction: results after 15 years. J Shoulder Elbow Surg 2018; 27 (05) 831-838
5 Westermann RW, Pugely AJ, Martin CT, Gao Y, Wolf BR, Hettrich CM. Reverse Shoulder Arthroplasty in the United States: A Comparison of National Volume, Patient Demographics, Complications, and Surgical Indications. Iowa Orthop J 2015; 35: 1-7
6 Checchia C, Domos P, Grimberg J, Kany J. Current Options in Tendon Transfers for Irreparable Rotator Cuff Tears. JBJS Rev 2019; 7 (02) e6
7 Castricini R, Longo UG, De Benedetto M. et al. Arthroscopic-Assisted Latissimus Dorsi Transfer for the Management of Irreparable Rotator Cuff Tears: Short-Term Results. J Bone Joint Surg Am 2014; 96 (14) e119
8 Grimberg J, Kany J, Valenti P, Amaravathi R, Ramalingam AT. Arthroscopic-assisted latissimus dorsi tendon transfer for irreparable posterosuperior cuff tears. Arthroscopy 2015; 31 (04) 599-607.e1
9 Habermeyer P, Magosch P, Rudolph T, Lichtenberg S, Liem D. Transfer of the tendon of latissimus dorsi for the treatment of massive tears of the rotator cuff: a new single-incision technique. J Bone Joint Surg Br 2006; 88 (02) 208-212
10 Iannotti JP, Hennigan S, Herzog R. et al. Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Factors affecting outcome. J Bone Joint Surg Am 2006; 88 (02) 342-348
11 Irlenbusch U, Bracht M, Gansen H-K, Lorenz U, Thiel J. Latissimus dorsi transfer for irreparable rotator cuff tears: a longitudinal study. J Shoulder Elbow Surg 2008; 17 (04) 527-534
12 Kany J, Sekaran P, Grimberg J. et al. Risk of latissimus dorsi tendon rupture after arthroscopic transfer for posterior superior rotator cuff tear: a comparative analysis of 3 humeral head fixation techniques. J Shoulder Elbow Surg 2020; 29 (02) 282-290
13 Moursy M, Forstner R, Koller H, Resch H, Tauber M. Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique to improve tendon transfer integrity. J Bone Joint Surg Am 2009; 91 (08) 1924-1931
14 Mihata T, Lee TQ, Fukunishi K. et al. Return to Sports and Physical Work After Arthroscopic Superior Capsule Reconstruction Among Patients With Irreparable Rotator Cuff Tears. Am J Sports Med 2018; 46 (05) 1077-1083
15 Burkhart SS, Hartzler RU. Superior Capsular Reconstruction Reverses Profound Pseudoparalysis in Patients With Irreparable Rotator Cuff Tears and Minimal or No Glenohumeral Arthritis. Arthroscopy 2019; 35 (01) 22-28
16 Aibinder WR, Elhassan BT. Lower trapezius transfer with Achilles tendon augmentation: indication and clinical results. Obere Extrem 2018; 13 (04) 269-272
17 Elhassan BT, Wagner ER, Werthel JD. Outcome of lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear. J Shoulder Elbow Surg 2016; 25 (08) 1346-1353
18 Gerber C, Rahm SA, Catanzaro S, Farshad M, Moor BK. Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: long-term results at a minimum follow-up of ten years. J Bone Joint Surg Am 2013; 95 (21) 1920-1926
19 Grimberg J, Kany J. Latissimus dorsi tendon transfer for irreparable postero-superior cuff tears: current concepts, indications, and recent advances. Curr Rev Musculoskelet Med 2014; 7 (01) 22-32
20 Warner JJ. Management of massive irreparable rotator cuff tears: the role of tendon transfer. Instr Course Lect 2001; 50: 63-71
21 Kany J, Grimberg J, Amaravathi RS, Sekaran P, Scorpie D, Werthel JD. Arthroscopically-Assisted Latissimus Dorsi Transfer for Irreparable Rotator Cuff Insufficiency: Modes of Failure and Clinical Correlation. Arthroscopy 2018; 34 (04) 1139-1150
22 Costouros JG, Espinosa N, Schmid MR, Gerber C. Teres minor integrity predicts outcome of latissimus dorsi tendon transfer for irreparable rotator cuff tears. J Shoulder Elbow Surg 2007; 16 (06) 727-734
23 Lehmann LJ, Cafaltzis K, Hünnebeck S, Moursy M. Are there any prognostic prediction parameters (PPPs) in the treatment of the massive rotator cuff tear with latissimus dorsi transfer? Latissimus dorsi transfer in massive rotator cuff tears. Acta Chir Orthop Traumatol Cech 2013; 80 (02) 125-130
24 Sher JS, Iannotti JP, Warner JJ, Groff Y, Williams GR. Surgical treatment of postoperative deltoid origin disruption. Clin Orthop Relat Res 1997; (343) 93-98
25 Miyazaki AN, Checchia CS, de Castro Lopes W, Fonseca Filho JM, Sella GDV, da Silva LA. Latissimus Dorsi Tendon Transfer using Tendinous Allograft for Irreparable Rotator Cuff Lesions: Surgical Technique. Rev Bras Ortop (Sao Paulo) 2019; 54 (01) 99-103
26 Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 1999; 8 (06) 599-605
27 Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res 1990; (254) 92-96
28 Codsi M. Clinical evaluation of shoulder problems. In: Rockwood Jr CA, Matsen 3rd FA, Wirth MA, Lippitt SB. editors The shoulder. 4th ed.. Philadelphia, PA: Saunders Elsevier; 2009: 148-176
29 Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am 1986; 68 (08) 1136-1144
30 Gerber C, Maquieira G, Espinosa N. Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg Am 2006; 88 (01) 113-120