Image: PD
1. Mean subjective shoulder value increased from 29% preoperatively to 70%
2. Pain score improved from 7 to 13/15 points.
3. Inferior results were associated with insufficiency of the subscapularis muscle and fatty infiltration of the teres minor muscle
Evidence Rating Level: 2 (Good)
Study Rundown: Latissimus dorsi tendon transfers in patients with inoperable posterosuperior rotator cuff tears had previously been shown to be effective in the short-term, but this is the first paper to demonstrate effectiveness after 10 years of follow-up. The one negative study result is patients had slightly higher osteoarthritic changes than they did post-operatively. Strengths of this study include its prospective follow up for more than 10 years, its single-surgeon outcomes and data to minimize inter-surgeon variability, and its use of established measures of outcomes, such as the Subjective Shoulder Value, to measure long-term outcomes. The major limitation of this study is the lack of a control group of patients to better understand how the shoulders of these patients would have changed otherwise. In addition, the exclusion of patients unable to stabilize their arms at 90 degrees of abduction preoperatively may predispose to a patient population that is more receptive to treatment, meaning the results of this study may not be generalizable outside that subgroup of patients.
Click to read the study in the Journal of Bone and Joint Surgery
Relevant Reading: Treatment options for massive rotator cuff tears
In-Depth [prospective cohort study]: This prospective cohort study, carried out by a single author in one institution from 1995 to 2001, evaluates the long-term outcomes of latissimus dorsi transfer for the treatment of inoperable posterosuperior rotator cuff tears, which had previously been shown to be effective in the short term. 57 tendon transfers were performed on 55 patients (2 were bilateral), with an average starting patient age of 56 and average follow up of 146.6 months. The final Subjective Shoulder Value (SSV) went up from 29% preoperatively to 70% (P < 0.001). The pain score improved from 7 to 13 points out of a 15 point scale by time of final follow up (P < 0.001). Unfortunately, there was a slight, but significant increase in osteoarthritic changes in the shoulders of patients at time of final follow up. An SSV of < 30% was considered failure, and 14 patients were in this category at time of final follow up. The degree of preoperative fatty infiltration of the teres minor muscle on MRI was greater in this patient subgroup (P = 0.03). Also, the subscapularis was deemed clinically insufficient in 29% of these patients vs. only 6% in patients with SSVs > 30% (P = 0.05).
By David Mattos and Allen Ho
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