title: Arthroscopic-assisted latissimus dorsi tendon transfer for irreparable posterosuperior cuff tears.
abstract: OBJECTIVE
  To evaluate, in a multicenter, prospective study, the clinical, magnetic resonance imaging (MRI), and radiologic results of arthroscopic-assisted latissimus dorsi (LD) tendon transfer for irreparable posterosuperior rotator cuff tears; and to assess the influence of perioperative data on clinical results.
  
  
  METHODS
  Fifty-five patients with irreparable tears of at least the supraspinatus and infraspinatus tendons were managed with arthroscopic-assisted LD tendon transfer and reviewed clinically, with standardized radiographs and MRI, after a mean of 29 months. Outcome measures included the Constant score and the Subjective Shoulder Value. The osteoarthritic stage and acromiohumeral distance were measured on standardized radiographs, and the transferred tendon aspect was evaluated on MRI.
  
  
  RESULTS
  Thirty patients had already undergone 1 or more previous surgical procedures. The mean Subjective Shoulder Value increased from 26% preoperatively to 71% postoperatively. The Constant score improved from 37 preoperatively to 65.4 postoperatively. The pain score increased from 1.7 preoperatively to 12.6 postoperatively; the activity score, from 6.4 to 13.8; active forward flexion, from 134° to 157°; active abduction, from 67° to 92.5°; active external rotation, from 29° to 41.5°; and abduction strength, from 1.4 kg to 4.8 kg. The only statistically significant factor negatively influencing the Constant score was previous surgery. Four patients had a ruptured LD tendon on MRI follow-up at 1 year. There was no statistical difference between preoperative and final follow-up acromiohumeral distance. There was no increase in osteoarthritic stage.
  
  
  CONCLUSIONS
  Arthroscopic-assisted LD tendon transfer improves shoulder pain and function in patients with irreparable posterosuperior cuff tears, with similar clinical and radiologic results compared with results of published series using open techniques. Patients with a history of surgery had lower Constant scores compared with non-previously operated patients.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: L'Institut de Recherché en Chirurgie Orthopédique et Sportive, Paris, France. Electronic address: j.grimberg@lircos.org.
authors.forename: Jean
authors.initials: J
authors.lastname: Grimberg
authors.affiliation: Clinique de l'Union, Saint Jean, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Kany
authors.affiliation: Clinique Jouvenet, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Valenti
authors.affiliation: St John's Medical College and Hospital, Bangalore, India.
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Amaravathi
authors.affiliation: Sarvajanik College of Physiotherapy, Surat, India.
authors.forename: Alagappan Thangamani
authors.initials: AT
authors.lastname: Ramalingam
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012399:Rotation; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000601:surgery; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery; D020069:Shoulder Pain / Q000601:surgery; D064171:Superficial Back Muscles; D013709:Tendon Transfer / Q000379:methods*; D016896:Treatment Outcome