Influence of fixation point of latissimus dorsi tendon transfer for irreparable rotator cuff tear on glenohumeral external rotation: A cadaver study.
Latissimus dorsi tendon transfer is a surgical option for treating irreparable posterosuperior rotator cuff tears, notably when attempting to reconstruct active external rotation. We hypothesized that the positioning of the transfer's point of fixation would differ depending on the desired elbow-to-body external rotation or external rotation with the elbow abducted.



Seven shoulders from four whole frozen cadavers were used. We created two systems to install the subject in a semi-seated position to allow external rotation elbow to body and the arm abducted 90°. Traction sutures were positioned on the latissimus dorsi muscle and a massive tear of the rotator cuff was created. We tested six different transfer positions. Muscle contraction of the latissimus dorsi was stimulated using 10-N and 20-N suspended weights.



The point of fixation of the latissimus dorsi on the humeral head had an influence on the elbow-to-body external rotation and with 90° abduction (P<0.001). The fixation point for a maximum external rotation with the elbow to the body was the anterolateral position (P<0.016). The fixation point for a maximum external rotation at 90° abduction was the position centered on the infraspinatus footprint (P<0.078).



The optimal point of fixation differs depending on whether external rotation is restored at 0° or 90° abduction.



Fundamental study, anatomic study.
Le Confluent-Nouvelles Cliniques Nantaises, Nantes, France. Electronic address: dr.bargoin@gmail.com.
K
K
Bargoin
Centre Hospitalier Universitaire, Nantes, France.
M
M
Boissard
Clinique de l'Union, Saint Jean, France.
J
J
Kany
Institut de recherche en chirurgie orthopédique et sportive, Paris, France.
J
J
Grimberg
D002102:Cadaver; D004551:Elbow Joint; D006801:Humans; D058430:Humeral Head; D016059:Range of Motion, Articular; D012399:Rotation; D000070636:Rotator Cuff Injuries / Q000601:surgery*; D064171:Superficial Back Muscles / Q000601:surgery*; D013709:Tendon Transfer / Q000379:methods*
Cadaver study; Joint range of movement; Latissimus dorsi; Rotator cuff tear; Tendon transfer