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Forschungsdatenbank PMU-SQQUID

Reverse shoulder arthroplasty combined with latissimus dorsi transfer using the bone-chip technique.
Ortmaier, R; Resch, H; Hitzl, W; Mayer, M; Blocher, M; Vasvary, I; Mattiassich, G; Stundner, O; Tauber, M;
Int Orthop. 2014; 38(3):553-559
Originalarbeiten (Zeitschrift)

PMU-Autor/inn/en

Blocher Martina
Hitzl Wolfgang
Mattiassich Georg
Mayer Michael
Ortmaier Reinhold
Resch Herbert
Stundner Ottokar
Tauber Mark

Abstract

PURPOSE
Reverse shoulder arthroplasty (RSA) can restore active elevation in rotator-cuff-deficient shoulders. However, RSA cannot restore active external rotation. The combination of latissimus dorsi transfer with RSA has been reported to restore both active elevation and external rotation. We hypothesised that in the combined procedure, harvesting the latissimus dorsi with a small piece of bone, leads to good tendon integrity, low rupture rates and good clinical outcome.
Between 2004 and 2010, 13 patients (13 shoulders) were treated with RSA in combination with latissimus dorsi transfer in a modified manner. The mean follow-up was 65.4 months, and the mean age at index surgery was 71.1 years. All patients had external rotation lag sign and positive hornblower"s sign, as well as radiological signs of cuff-tear arthropathy (Hamada 3, 4 or 5) and fatty infiltration grade 3 according to Goutallier et al. on magnetic resonance imaging (MRI). The outcome measures included the Constant Murley Score, University of California-Los Angeles (UCLA) shoulder score, Simple Shoulder Test (SST), visual analogue scale (VAS) and the Activities of Daily Living Requiring External Rotation (ADLER) score. Tendon integrity was evaluated with dynamic ultrasound. All patients were asked at final follow-up to rate their satisfaction as excellent, good, satisfied or dissatisfied.
The overall mean Constant-Murley Shoulder Outcome Score (CMS) improved from 20.4 to 64.3 points (p < 0.001). Mean VAS pain score decreased from 6.8 to 1.1 (p < 0.001)., mean UCLA score improved from 7.9 to 26.4 (p < 0.001), mean SST score improved from 2.3 to 7.9 (p < 0.001) and mean postoperative ADLER score was 26 points. The average degree of abduction improved from 45° to 129° (p < 0.001), the average degree of anterior flexion improved from 55° to 138° (p < 0.001) and the average degree of external rotation improved from -16° to 21° (p < 0.001). Eight patients rated their results as very satisfied, three as satisfied and two as dissatisfied.
This modified technique, which avoids cutting the pectoralis major tendon and involves harvesting the tendon together with a small piece of bone, leads to good or even better functional results compared with the results reported in the literature, and also has high patient satisfaction and low failure rates.


Useful keywords (using NLM MeSH Indexing)

Activities of Daily Living

Aged

Arthroplasty/methods*

Female

Follow-Up Studies

Humans

Magnetic Resonance Imaging

Male

Middle Aged

Osteotomy/methods*

Outcome Assessment (Health Care)

Pain Measurement

Patient Satisfaction

Range of Motion, Articular/physiology

Retrospective Studies

Rotator Cuff/injuries*

Rotator Cuff/surgery*

Shoulder Joint/physiopathology

Shoulder Joint/surgery*

Superficial Back Muscles/surgery

Superficial Back Muscles/transplantation*

Treatment Outcome


Find related publications in this database (Keywords)

Reverse shoulder arthroplasty
Latissimus dorsi transfer
External rotation
Bone-chip technique