title: Long-term follow-up after latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears.
abstract: BACKGROUND
  Irreparable posterosuperior rotator cuff tears are treated in several ways. Transfer of the latissimus dorsi is an alternative with acceptable mid-term results, but long-term results have rarely been published.
  
  
  METHODS
  The cases of 108 consecutive patients with 115 shoulders treated with latissimus dorsi transfer between 2000 and 2005 were reviewed clinically and radiographically. Ninety-three shoulders in eighty-six patients were included in the follow-up analysis. The mean duration of follow-up was 9.3 years (range, 6.6 to 11.7 years), and the mean age at the operation was fifty-six years (range, forty to seventy-two years). Outcome measures included the Constant-Murley score (Constant score), American Shoulder and Elbow Surgeons (ASES) index, and visual analog scale (VAS) for pain. The progress of cuff tear arthropathy was determined with radiographic evaluation according to the system described by Hamada et al.
  
  
  RESULTS
  The mean relative Constant score improved from 44% preoperatively to 71% at the time of follow-up (p < 0.0001, effect size = 0.6), excluding the clinical failures. Similarly, the mean ASES index improved from 30 to 70 (p < 0.0001, effect size = 0.7), and the mean VAS score decreased from 7.8 to 2.4 (p < 0.0001, effect size = 0.8). A pain-free outcome was reported in only eighteen shoulders (19%). Active shoulder movement improved significantly (p < 0.05). The mean Hamada radiographic grade of cuff tear arthropathy increased from 1.7 (range, 0 to 2) preoperatively to 2.2 (range, 1 to 5) (p < 0.0001, effect size = 0.2). The rate of clinical failure of latissimus dorsi transfer was 10%, and the rate of shoulder prosthetic replacement after latissimus dorsi transfer was 4%.
  
  
  CONCLUSIONS
  Pain relief and improvement of shoulder function were maintained a mean of 9.3 years after latissimus dorsi transfer for irreparable posterosuperior cuff defects. The younger the patient, the better the outcome.
authors: Kings Valley Hospital, Luxor, Egypt.
authors: Hossam Mahmoud
authors: HM
authors: El-Azab
authors: Department of Orthopaedic Surgery, Marienstift Arnstadt, Wachsenburgallee 12, D-99310 Arnstadt, Germany. E-mail address for U. Irlenbusch: irlenbusch@ms-arn.de.
authors: Olaf
authors: O
authors: Rott
authors: Department of Orthopaedic Surgery, Marienstift Arnstadt, Wachsenburgallee 12, D-99310 Arnstadt, Germany. E-mail address for U. Irlenbusch: irlenbusch@ms-arn.de.
authors: Ulrich
authors: U
authors: Irlenbusch
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058430:Humeral Head / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D000070636:Rotator Cuff Injuries; D064171:Superficial Back Muscles / Q000637:transplantation*; D013708:Tendon Injuries / Q000601:surgery*; D013709:Tendon Transfer; D016896:Treatment Outcome