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abstract
Seven patients who had a previously failed attempt at debridement and repair of a massive rotator cuff tear were managed with latissimus dorsi transfer. Patient age averaged 63 years and average follow-up was 31 months. All patients were evaluated with shoulder radiographs, Constant and Murley Scores, UCLA Shoulder Score, visual analog pain score, range of motion, and the Short Shoulder Form. Modest improvement was noted in forward flexion and abduction. Significant improvement was noted in shoulder function. Transfer of the latissimus dorsi as salvage for a previously failed repair of a massive rotator cuff tear is effective in providing pain relief and improving shoulder function.
Rotator cuff pathology was formally characterized by Codman1 in 1934. The primary goals of rotator cuff repair are to decrease pain and improve shoulder function. Most reported repair techniques involve tear debridement, tendon mobilization, and primary repair of tendon to bone. Larger tears may also necessitate rotator interval releases.2'4 Early reports of rotator repair techniques demonstrated only moderate success; however, recent techniques, including the use of anterior and posterior releases, have yielded improved outcomes after repair.2,5-10
Often, large or massive rotator cuff tears (>5 cm) cannot be primarily repaired despite extensive mobilization and interval releases. In these instances, the surgeon has the option of tear debridement or the use of a static or dynamic soft tissue transfer.2'11'23 This article reviews 7 patients who underwent dynamic latissimus dorsi muscle transfer with ipsilateral fascia lata augmentation for an irreparable posterosuperior rotator cuff tear.
MATERIALS AND METHODS
Between 1999 and 2003, 8 patients (8 shoulders) who previously had undergone failed arthroscopic or mini-open debridement and repair of a massive rotator cuff tear (>5 cm) underwent transfer of the latissimus dorsi muscle with ipsilateral fascia lata augmentation. All patients completed physical therapy after their original procedure. In addition, after the diagnosis of a failed rotator cuff, each patient underwent 6 weeks of physical therapy before consideration of latissimus dorsi transfer.
Average patient age was 63 years (range, 51-80 years). There were 4 women and 3 men. The right shoulder was affected in 4 patients and the left in 3. Three injuries were to the dominant arm and 4 to the nondominant arm. Average follow-up was 31 months (range, 12-58 months).
Despite...