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Current Reviews in Musculoskeletal Medicine
Published in: Current Reviews in Musculoskeletal Medicine 5/2020

Open Access 01-10-2020 | Osteoarthrosis | Surgical Management of Massive Irreparable Cuff Tears (J Sanchez-Sotelo, Section Editor)

Surgical Management of Massive Irreparable Cuff Tears: Latissimus Dorsi Transfer for Posterosuperior Tears

Authors: Karl Wieser, Lukas Ernstbrunner, Matthias A. Zumstein

Published in: Current Reviews in Musculoskeletal Medicine | Issue 5/2020

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Abstract

Purpose of Review

This review aims to describe the role of the latissimus dorsi transfer (LDT) for patients with irreparable posterosuperior rotator cuff tears (RCTs).

Recent Findings

Historically, the LDT has been performed as an open (double-incision) procedure for neurologically intact, relatively young patients with irreparable posterosuperior RCTs with disabling loss of active external rotation with or without impaired active elevation. The transferred tendon reconstitutes the posterior rotator cuff and force couple, respectively and thus has the potential to function effectively as an external rotator and humeral head depressor. Long-term results of the open technique have demonstrated in the majority of patients substantial and durable improvements in shoulder function and pain relief at the 10-year benchmark. With the advancements of arthroscopic surgery, the LDT was expanded to an arthroscopically assisted procedure with promising short-term results. In addition to adequate technical performance, the success of the procedure depends on preoperative factors, such as exclusion of glenohumeral osteoarthritis and acromial acetabularization; intact or reparable subscapularis tendon; intact (or hypertrophic) teres minor muscle; adequate preoperative activity of the latissimus dorsi; and normal or mild impairment of overhead function.

Summary

The LDT (open or arthroscopically assisted) is a reliable treatment option for patients with massive, irreparable posterosuperior RCTs with disabling loss of active external rotation, with or without diminished overhead function and without advanced glenohumeral osteoarthritis. Precise patient selection is of tremendous importance in the success of the LDT.
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Metadata
Title
Surgical Management of Massive Irreparable Cuff Tears: Latissimus Dorsi Transfer for Posterosuperior Tears
Authors
Karl Wieser
Lukas Ernstbrunner
Matthias A. Zumstein
Publication date
01-10-2020
Publisher
Springer US
Published in
Current Reviews in Musculoskeletal Medicine / Issue 5/2020
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-020-09659-3

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