title: Combined pectoralis major and latissimus dorsi tendon transfer for massive rotator cuff deficiency.
abstract: This report is a retrospective review of 11 consecutive patients treated with a combined transfer of the latissimus dorsi and pectoralis major tendons for massive rotator cuff deficiency. Each patient's chief complaint was diminished shoulder function and motion with little or no accompanying pain. The primary operative objective was to increase active shoulder motion. All 11 patients were followed up for at least 2 years (range, 24 to 42 months). The mean active elevation improved from 42 degrees preoperatively to 86 degrees postoperatively. The mean active external rotation improved from 0 degrees to 13 degrees. On the basis of the Medical Research Council scale, the mean abduction strength improved from 2.3 to 3.1 and the mean external rotation strength improved from 2.1 to 2.7. Overall, 4 patients made no improvement, 2 improved slightly, and 5 improved significantly. We conclude that a combined transfer of the latissimus dorsi and pectoralis major is a reasonable and safe procedure that may restore active elevation and external rotation in some patients' shoulders with a massive rotator cuff deficiency that have not responded favorably to traditional nonoperative and operative techniques. However, it is difficult to conclude, based on our experience, for which patients this surgery can be predictably successful.
authors.affiliation: Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA. aldri004@mc.duke.edu
authors.forename: J Mack
authors.initials: JM
authors.lastname: Aldridge
authors.forename: Todd S
authors.initials: TS
authors.lastname: Atkinson
authors.forename: William J
authors.initials: WJ
authors.lastname: Mallon
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D019637:Orthopedic Procedures / Q000379:methods; D010147:Pain Measurement; D010369:Pectoralis Muscles / Q000637:transplantation; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D017006:Rotator Cuff / Q000503:physiopathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000503:physiopathology; D013709:Tendon Transfer / Q000379:methods*; D016896:Treatment Outcome