title: Reverse shoulder arthroplasty combined with a latissimus dorsi and teres major transfer for a deficit of both active elevation and external rotation. Results of 15 cases with a minimum of 2-year follow-up.
abstract: OBJECTIVE
  Our aim was to assess the clinical and radiological outcomes of reverse shoulder replacements performed in association with a latissimus dorsi and teres major tendon transfer in cases of irreparable posterosuperior cuff tears including the teres minor tendon. Our hypothesis was that the tendon transfers would improve the clinical results of arthroplasty by restoring active external rotation.
  
  
  METHODS
  Fifteen procedures in 14 patients were performed through a single deltopectoral approach. Both tendons were fixed to the proximal anterolateral aspect of the humeral metaphysis. Mean age at the time of surgery was 67.5 years (range 53 to 82 years). All had severe cuff tear arthropathy (Hamada stage 3 or 4) and severe atrophy or fatty infiltration of the infraspinatus and teres minor on preoperative MRI or CT-scan (Goutallier stage 3 or 4). Preoperative and postoperative functions were assessed by Constant score. Satisfaction was assessed by the Simple Shoulder Test (SST). At follow up, radiographs were examined for radiolucent lines, osteolysis and scapular notching.
  
  
  RESULTS
  The average follow-up after surgery was 33.2 months (range 24 to 60 months). The mean absolute Constant score improved significantly (P=10(-5)) from 23.7±11.5 preoperatively to 61.1±11.9 postoperatively. Forward flexion and external rotation with the arm at the side improved significantly, respectively from 64.7±35.6° preoperatively to 126±34.4° postoperatively (P<10(-5)) and from -8.7±21.3° to 27.3±12.2° (P<0.0005). Internal rotation was not affected. The mean SST improved from 1.9±1.6 points preoperatively to 7.6±1.8 points postoperatively (P<0.0005). Twelve patients were very satisfied or satisfied (including one with a bilateral procedure) and 2 were unsatisfied with the final result. At final follow-up, radiographs showed no radiolucent lines around the implants nor scapular notching.
  
  
  CONCLUSIONS
  The combined procedure helped restoration of active elevation and external rotation in cases of massive cuff tear including the teres minor tendon.
  
  
  METHODS
  Therapeutic Level IV.
authors.affiliation: Department of Orthopaedic Surgery and Sports Trauma, hôpital privé Armand-Brillard, 3, avenue Watteau, 94130 Nogent-sur-Marne , France. Omar.Boughebri@gmail.com
authors.forename: O
authors.initials: O
authors.lastname: Boughebri
authors.forename: A
authors.initials: A
authors.lastname: Kilinc
authors.forename: P
authors.initials: P
authors.lastname: Valenti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012399:Rotation; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D053441:Suture Anchors; D013709:Tendon Transfer; D016896:Treatment Outcome