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Latissimus Dorsi Transfer for Management of Irreparable Subscapularis Tendon Tears

March 01, 2019

Contributors: Young Woong Back, MD; Jong Soo Oh, MD; Seung Hoon Yi; Chang Hee Baek, MD; Chang Hee Baek, MD

Several tendon transfers are available for the reconstruction of irreparable subscapularis tears. The latissimus dorsi can be used because its direction and function are similar to that of the subscapularis. We performed and evaluated the clinical outcomes of latissimus dorsi transfer for the management of irreparable subscapularis tears. The study included 24 consecutive patients who underwent latissimus dorsi transfer. Clinical and functional outcomes were evaluated using the Constant assessment score, American Shoulder and Elbow Surgeons Shoulder score, visual analog scale for pain, and range of shoulder motion. The lift-off and belly-press tests were performed to assess subscapularis integrity and function. MRI was obtained preoperatively and 1 year postoperatively to evaluate tendon integrity. The mean Constant assessment score, American Shoulder and Elbow Surgeons Shoulder score, and pain visual analog scale score improved from 46 ± 6 preoperatively to 69 ± 5 at final follow up (P < 0.001), from 40 ± 3 preoperatively to 70 ± 5 at final follow up (P < 0.001), and from 6 ± 1 preoperatively to 2 ± 1 at final follow up (P = 0.006), respectively. The mean range of motion for forward elevation and internal rotation increased from 135° ± 17° preoperatively to 166° ± 15° at final follow up (P = 0.016) and from L5 to L1 (P = 0.010), respectively. Improvements in mean range of motion for external rotation were not significant (from 51° ± 7° preoperatively to 68° ± 7° at final follow up; P = 0.062). At final follow up, the belly-press test was negative in 18 of 24 patients, and the lift-off test was negative in 16 of 20 patients. No complications related to tendon transfer, including axillary and radial nerve injury, were reported. No retearing of the transferred latissimus dorsi was observed. Latissimus dorsi transfer resulted in pain relief and restored shoulder range of motion and function. Latissimus dorsi transfer is an effective and safe salvage treatment option for patients with an irreparable subscapularis tear.

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