Background: Treatment of irreparable rotator cuff tears remains
controversial. Latissimus dorsi transfer to the greater tuberosity has been
proposed for the treatment of irreparable tears associated with severe
functional impairment and chronic, disabling pain.
Methods: Sixty-seven patients with sixty-nine irreparable,
full-thickness tears of at least two complete tendons were managed with
latissimus dorsi transfer and were reviewed clinically and radiographically
after an average of fifty-three months. The study group included fifty-two men
and fifteen women, with an average age of sixty-one years. Thirteen patients
also had deficient subscapularis function preoperatively. Outcome measures
included the Constant and Murley score and the Subjective Shoulder Value.
Osteoarthritis and acromiohumeral distance were measured on standardized
Results: The mean Subjective Shoulder Value increased from 28%
preoperatively to 66% at the time of follow-up (p < 0.0001). The mean age
and gender-matched Constant and Murley score improved from 55% to 73% (p <
0.0001). The pain score improved from 6 to 12 points (of a possible 15 points)
(p < 0.0001). Flexion increased from 104° to 123°, abduction
increased from 101° to 119°, and external rotation increased from
22° to 29° (p < 0.05). Abduction strength increased from 0.9 to 1.8
kg (p < 0.0001). There was a slight but significant increase in
osteoarthritic changes (from stage 0.8 to stage 1.3; p = 0.0002). In shoulders
with a negative preoperative lift-off test, significant improvements were
observed in terms of both function and pain, and strength doubled from 1.0 to
2.0 kg (p = 0.0001), but osteoarthritic changes progressed from stage 0.7 to
stage 1.1 (p = 0.0006). In shoulders with poor subscapularis function, no
improvement in these parameters was observed.
Conclusions: Latissimus dorsi transfer durably and substantially
improves chronically painful, dysfunctional shoulders with irreparable rotator
cuff tears, especially if the subscapularis is intact. If subscapularis
function is deficient, the procedure is of questionable benefit and probably
should not be used.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.