Graft-Augmented Repair of Irreparable Massive Rotator Cuff Tears with Latissimus Dorsi Transfer to Treat Pseudoparesis

Background:. Irreparable massive rotator cuff tears are characterized by a poor prognosis with high failure rates following repair. Numerous strategies, such as partial repair, graft interposition, latissimus dorsi (LD) transfer, balloon arthroplasty, and superior capsular reconstruction, have been...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autor principal:	Shinji Imai, MD, PhD
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/c7cb8530841e4ff598262cbda281d6dd
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:c7cb8530841e4ff598262cbda281d6dd
record_format	dspace
spelling	oai:doaj.org-article:c7cb8530841e4ff598262cbda281d6dd2021-11-25T07:59:02ZGraft-Augmented Repair of Irreparable Massive Rotator Cuff Tears with Latissimus Dorsi Transfer to Treat Pseudoparesis2472-724510.2106/JBJS.OA.21.00044https://doaj.org/article/c7cb8530841e4ff598262cbda281d6dd2021-12-01T00:00:00Zhttp://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.21.00044https://doaj.org/toc/2472-7245Background:. Irreparable massive rotator cuff tears are characterized by a poor prognosis with high failure rates following repair. Numerous strategies, such as partial repair, graft interposition, latissimus dorsi (LD) transfer, balloon arthroplasty, and superior capsular reconstruction, have been proposed. We have adopted a graft-augmented LD-transfer procedure, in which partial repair, graft interposition, and LD transfer are performed simultaneously. Methods:. Thirty-nine patients underwent the graft-augmented LD-transfer procedure using autologous fascia lata from 2007 to 2016. All patients underwent a 5-year assessment at a mean (and standard deviation) of 54.8 ± 3.5 months. Of 20 patients with a history of >10 years, 14 underwent a 10-year assessment at a mean of 112.6 ± 5.6 months. To characterize the therapeutic effects of the procedure, the patients were divided into 3 groups according to the tear pattern: superior-posterior tears (Group A), superior-anterior tears (Group B), and global tears (Group C). Results:. The overall mean Constant-Murley score improved from 33.8 ± 5.3 preoperatively to 63.1 ± 9.4 at the 5-year assessment (p < 0.001). The overall mean active anterior elevation (AE) improved from 57.3° ± 13.2° preoperatively to 131.3° ± 18.2° at 5 years (p < 0.001). Preoperatively, AE was significantly different between Groups A and C (p < 0.001) and between Groups B and C (p < 0.001), reflecting the difference in cuff tear patterns. Postoperatively, AE was significantly higher in Group A than in Groups B (p < 0.001) and C (p < 0.001). The present study also showed that AE was electromyographically synchronized to the contraction of the transferred LD. The transferred LD was kinetically more potent at a slower speed, but it was easier to exhaust, than the native rotator cuff. Osteoarthritis progression was radiographically found to occur during the first 5 years. Conclusions:. The graft-augmented LD-transfer procedure may be a treatment option for massive rotator cuff tears, especially for active patients who are <60 years old. Level of Evidence:. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.Shinji Imai, MD, PhDWolters KluwerarticleOrthopedic surgeryRD701-811ENJBJS Open Access, Vol 6, Iss 4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Orthopedic surgery RD701-811
spellingShingle	Orthopedic surgery RD701-811 Shinji Imai, MD, PhD Graft-Augmented Repair of Irreparable Massive Rotator Cuff Tears with Latissimus Dorsi Transfer to Treat Pseudoparesis
description	Background:. Irreparable massive rotator cuff tears are characterized by a poor prognosis with high failure rates following repair. Numerous strategies, such as partial repair, graft interposition, latissimus dorsi (LD) transfer, balloon arthroplasty, and superior capsular reconstruction, have been proposed. We have adopted a graft-augmented LD-transfer procedure, in which partial repair, graft interposition, and LD transfer are performed simultaneously. Methods:. Thirty-nine patients underwent the graft-augmented LD-transfer procedure using autologous fascia lata from 2007 to 2016. All patients underwent a 5-year assessment at a mean (and standard deviation) of 54.8 ± 3.5 months. Of 20 patients with a history of >10 years, 14 underwent a 10-year assessment at a mean of 112.6 ± 5.6 months. To characterize the therapeutic effects of the procedure, the patients were divided into 3 groups according to the tear pattern: superior-posterior tears (Group A), superior-anterior tears (Group B), and global tears (Group C). Results:. The overall mean Constant-Murley score improved from 33.8 ± 5.3 preoperatively to 63.1 ± 9.4 at the 5-year assessment (p < 0.001). The overall mean active anterior elevation (AE) improved from 57.3° ± 13.2° preoperatively to 131.3° ± 18.2° at 5 years (p < 0.001). Preoperatively, AE was significantly different between Groups A and C (p < 0.001) and between Groups B and C (p < 0.001), reflecting the difference in cuff tear patterns. Postoperatively, AE was significantly higher in Group A than in Groups B (p < 0.001) and C (p < 0.001). The present study also showed that AE was electromyographically synchronized to the contraction of the transferred LD. The transferred LD was kinetically more potent at a slower speed, but it was easier to exhaust, than the native rotator cuff. Osteoarthritis progression was radiographically found to occur during the first 5 years. Conclusions:. The graft-augmented LD-transfer procedure may be a treatment option for massive rotator cuff tears, especially for active patients who are <60 years old. Level of Evidence:. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
format	article
author	Shinji Imai, MD, PhD
author_facet	Shinji Imai, MD, PhD
author_sort	Shinji Imai, MD, PhD
title	Graft-Augmented Repair of Irreparable Massive Rotator Cuff Tears with Latissimus Dorsi Transfer to Treat Pseudoparesis
title_short	Graft-Augmented Repair of Irreparable Massive Rotator Cuff Tears with Latissimus Dorsi Transfer to Treat Pseudoparesis
title_full	Graft-Augmented Repair of Irreparable Massive Rotator Cuff Tears with Latissimus Dorsi Transfer to Treat Pseudoparesis
title_fullStr	Graft-Augmented Repair of Irreparable Massive Rotator Cuff Tears with Latissimus Dorsi Transfer to Treat Pseudoparesis
title_full_unstemmed	Graft-Augmented Repair of Irreparable Massive Rotator Cuff Tears with Latissimus Dorsi Transfer to Treat Pseudoparesis
title_sort	graft-augmented repair of irreparable massive rotator cuff tears with latissimus dorsi transfer to treat pseudoparesis
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/c7cb8530841e4ff598262cbda281d6dd
work_keys_str_mv	AT shinjiimaimdphd graftaugmentedrepairofirreparablemassiverotatorcufftearswithlatissimusdorsitransfertotreatpseudoparesis
_version_	1718413584968450048

Graft-Augmented Repair of Irreparable Massive Rotator Cuff Tears with Latissimus Dorsi Transfer to Treat Pseudoparesis

Ejemplares similares