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[Latissimus dorsi transfer--comparison of results after primary and revision surgery: a retrospective matched-pair
S Buchmann1, P Magosch, S Lichtenberg
1Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Connollystrasse 32, Munich. s_buchmann17@hotmail.com
Aim:
Latissimus dorsi transfer (LdT) has been proposed for the treatment of irreparable rotator cuff tears of the infra- and supraspinatus. The purpose of this retrospective study was to evaluate the results of latissimus dorsi transfer in revision surgery in comparison to primary surgery.
Method:
Between 1998 and 2005 a group of 124 patients has been treated with a latissimus dorsi transfer. From this group 34 patients (Group 1 = revision LdT n = 17, Group 2 = primary LdT n = 17)were examined in a retrospective matched-pair study after an average follow-up of 20 months (Group 1) and 28 months (Group 2) by clinical examination and X-ray. Functional results were assessed with use of the age- and gender-matched Constant Score (CS).
Results:
The age- and gender-matched Constant Score increased significantly in both groups from preoperatively 51% in Group 1 and 57% in Group 2 up to a postoperative score of 73% in Group 1 and 84% in Group 2 (p = 0.001/p = 0.007). By comparison of the 2 groups there is a significantly higher postoperative age- and gender-matched Constant Score for Group 2 (p = 0.03). Active ROM showed postoperatively no significant difference (Abd/Flex p = 0.8). The Hornblower sign is significantly more frequently positive in Group 1(p < 0.001). The comparison of arthroscopically and open previous surgery for the subgroups of revision latissimus dorsi transfer shows a trend for an increased postoperative age- and gender-matched Constant Score in the arthroscopic group (82%/69% p = 0.06) with a preoperative CS of 50%/52% (p = 0.9). There is no significant difference in the incidence of postoperative complications.
Conclusion:
Considering the correct indication for latissimus dorsi transfer there is no difference for reduction of pain and active ROM between primary and revision surgery. But the revision cases show a significantly lower age- and gender-matched Constant Score and a higher incidence of a positive Hornblower sign. A higher risk of postoperative complications for the revision group could not be found. In summary, the latissimus dorsi transfer was of significant benefit for both groups and we can also recommend this technique for revision surgery.