Reverse shoulder arthroplasty combined with latissimus dorsi transfer using the bone-chip technique

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Research
• Biomechanical Engineering

Background:

• Reverse shoulder arthroplasty (RSA) restores elevation but not external rotation in rotator-cuff-deficient shoulders.
• Combining RSA with latissimus dorsi transfer can potentially restore both active elevation and external rotation.
• The integrity of the harvested latissimus dorsi tendon is crucial for successful outcomes in combined procedures.

Purpose of the Study:

• To evaluate the clinical outcomes of a modified latissimus dorsi transfer combined with RSA.
• To assess tendon integrity, rupture rates, and patient satisfaction following the combined procedure.
• To determine if harvesting the latissimus dorsi with a small bone fragment improves functional results.

Main Methods:

• A modified technique involving RSA and latissimus dorsi transfer was performed on 13 patients (2004-2010).
• Patients had significant rotator cuff deficiency (Hamada 3-5, Goutallier grade 3 fatty infiltration).
• Outcomes were assessed using Constant Murley Score, UCLA score, SST, VAS, ADLER score, dynamic ultrasound, and patient satisfaction surveys at a mean 65.4-month follow-up.

Main Results:

• Significant improvements were observed in Constant Murley (20.4 to 64.3), UCLA (7.9 to 26.4), SST (2.3 to 7.9), and VAS pain (6.8 to 1.1) scores (p < 0.001).
• Mean abduction improved from 45° to 129°, anterior flexion from 55° to 138°, and external rotation from -16° to 21° (p < 0.001).
• Eight patients reported excellent satisfaction, three were satisfied, and two were dissatisfied.

Conclusions:

• The modified latissimus dorsi transfer technique, preserving the pectoralis major tendon and harvesting with bone, yields favorable functional results.
• This approach demonstrates high patient satisfaction and low failure rates in rotator-cuff-deficient shoulders treated with RSA.
• The technique offers a viable solution for restoring both elevation and external rotation in complex shoulder pathologies.