title: Secondary latissimus dorsi transfer after failed reverse total shoulder arthroplasty.
abstract: Combined single-stage reverse total shoulder arthroplasty (RTSA) plus latissimus dorsi transfer (LDT) has been reported to be a reliable treatment for pseudoparalysis of elevation and external rotation caused by irreparable rotator cuff tears. Secondary LDT in patients with pseudoparalysis of external rotation after previous RTSA has not yet been studied.
  
  
  
  Ten patients were treated with LDT at a mean of 27 months (range, 4-134 months) after RTSA. Standard LDT was performed in 4 patients and a LDT plus teres major transfer according to L'Episcopo in 6 patients. All patients had preoperative and postoperative clinical evaluation, including the assessment of the Constant score and the subjective shoulder value.
  
  
  
  RTSA increased the preoperative mean relative Constant score from 26% (range, 11%-67%) to 51% (range, 20%-100%; P = .05). At a mean of 49 months (range, 23-67 months) after additional LDT, the relative Constant score further increased to 58% (range, 34%-100%; P = .141), remaining significantly superior to the score before RTSA (P = .021). The mean subjective shoulder value was 15% (range, 0%-30%) before and 44% (range, 20%-70%) after RTSA (P = .273) and was 56% (range, 20%-90%) after LDT (P = .686), a significant overall improvement of the state of the shoulder compared with before RTSA (P = .042). Mean active flexion increased from 36° (range, 0°-130°) to 86° (range, 10°-140°) after RTSA (P = .024) and to 109° (range,70°-140°) after LDT (P = 0.017 compared with pre-LDT; P = .011 compared with pre-RTSA). Mean active external rotation decreased from 0° (range, -80° to 50)° to -18° (range, -50°to 10)° after RTSA (P = .079) and was improved to 2° (-40° to 40)° after LDT (P = .24 compared with pre-LDT; P=.865 compared with pre RTSA).
  
  
  
  Secondary LDT significantly improves active mobility in patients with residual dysfunction after RTSA.
authors.affiliation: Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
authors.forename: Gabor J
authors.initials: GJ
authors.lastname: Puskas
authors.affiliation: Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Germann
authors.affiliation: Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Catanzaro
authors.affiliation: Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland. Electronic address: christian.gerber@balgrist.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Gerber
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012399:Rotation; D012785:Shoulder Joint / Q000601:surgery*; D013709:Tendon Transfer
keywords: Reverse total shoulder arthroplasty; clinical outcome; irreparable rotator cuff tear; pseudoparalysis of elevation; pseudoparalysis of external rotation; secondary Latissimus dorsi transfer