title: Recovery of active external rotation and elevation in young active men with irreparable posterosuperior rotator cuff tear using arthroscopically assisted latissimus dorsi transfer.
abstract: BACKGROUND
  Massive irreparable posterosuperior rotator cuff tears represent a serious functional disablement for young and active patients in their daily activities. Latissimus dorsi (LD) muscle-tendon transfer can restore elevation and external rotation where supraspinatus and infraspinatus function is lost.
  
  
  METHODS
  Between 2009 and 2013, 45 consecutive patients underwent arthroscopically assisted LD transfer for an irreparable posterosuperior rotator cuff tear. Thirty-three patients agreed to participate in this retrospective study. For 8 patients, we used a standard passage of the LD through the plane between the infraspinatus-teres minor and the deltoid muscles. For the remaining 25 patients, we transferred the LD tendon in front of the triceps muscle according to a personal described technique. The follow-up period was 35.7 months. Final follow-up included assessment by standard radiographs, bipolar surface electromyography, pain score by visual analog scale, Constant-Murley shoulder score, and Disabilities of the Arm, Shoulder, and Hand score. For quantitative strength evaluation measurements, a Biodex dynamometer was used.
  
  
  RESULTS
  Overall clinical outcomes improved at the final follow-up and were significantly age related. We found similar results for revision and primary patients with mean increase in Constant-Murley scores of 29.5 and 30.5 points, respectively. In our series, we recorded osteoarthritis progression in 33.3% of patients.
  
  
  CONCLUSIONS
  Arthroscopic LD tendon transfer for irreparable posterosuperior rotator cuff tears can achieve good clinical outcomes at a midterm follow-up, especially in active men 60 years of age or younger and in patients with low preoperative elevation (<80°) but an intact or reparable subscapularis tendon.
authors.affiliation: Department of Orthopedics, Istituto Clinico Città di Brescia, Brescia, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Petriccioli
authors.affiliation: Department of Orthopedics, Istituto Clinico Città di Brescia, Brescia, Italy. Electronic address: bercel1971@gmail.com.
authors.forename: Celeste
authors.initials: C
authors.lastname: Bertone
authors.affiliation: Department of Orthopedics, Istituto Clinico Città di Brescia, Brescia, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Marchi
mesh_terms: D001182:Arthroscopy; D004185:Disability Evaluation; D004576:Electromyography; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012399:Rotation; D000070636:Rotator Cuff Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D064171:Superficial Back Muscles / Q000601:surgery*; D013709:Tendon Transfer; D064232:Visual Analog Scale
keywords: Irreparable rotator cuff tears; arthroscopy; electromyography; isokinetic dynamometer; latissimus dorsi; tendon transfer