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Transfer of the Latissimus Dorsi Muscle After Failed Repair of a Massive Tear of the Rotator Cuff. A two to five-year Review*
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Investigation performed at The Toronto Hospital, Western Division, University of Toronto, Toronto, and the London Health Sciences Centre, University of Western Ontario, London
J Bone Joint Surg Am, 1999 Aug 01;81(8):1120-7
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Introduction: Seventeen patients with an average age of fifty-five years (range, thirty-two to seventy-seven years) who had ongoing pain and impaired function following failed operative treatment of a massive tear of the rotator cuff were managed with a transfer of the latissimus dorsi muscle as a salvage operation.Methods: The patients were examined at an average of fifty-one months (range, twenty-four to seventy-two months) after the operation. Pain, function, and satisfaction were assessed with use of a questionnaire, visual analog and ordinal scales, physical examination, and the University of California at Los Angeles shoulder score.Results: Fourteen of the seventeen patients were found to have significant relief of pain (p < 0.0001) and a significant improvement in function (p < 0.001 for all activities except lifting more than fifteen pounds [6.8 kilograms], for which the p value was <0.0036) and were satisfied with the result of the operative procedure. Fifteen patients stated that they would have the operative procedure again under similar circumstances. Seven of eight patients with a detached or nonfunctional anterior portion of the deltoid had substantial improvement. Three operations were classified as failures because the patients were not satisfied with the result and had ongoing pain and impaired function. All three failures were in patients who had a work-related injury. Overall, six patients had a work-related injury, and only three of them had a satisfactory result. There were three complications, all related to contracture of a hypertrophic axillary scar.Conclusions: The results in this series indicate that transfer of the latissimus dorsi muscle is a reasonable approach for salvage after failed operative treatment of a massive tear of the rotator cuff.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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