Mid-term clinical and functional outcomes after reverse shoulder arthroplasty with latissimus dorsi transfer

Although reverse total shoulder arthroplasty (rTSA) with concomitant latissimus dorsi transfer (LDT) has been shown to effectively treat external rotation (ER) deficits, there are limited data regarding its outcomes with modern implants and its impact on activities of daily living (ADLs) requiring ER. The purpose of this study was to assess the mid-term clinical and radiographic outcomes of rTSA with concomitant isolated LDT in patients with an ER lag sign and posterior rotator cuff deficiency.

This retrospective cohort study with prospective follow-up included consecutive patients who underwent rTSA with concomitant isolated LDT between 2010 and 2022 with a minimum follow-up of 2 years. Primary outcomes included the resolution of ER lag sign, active ER, and the Activities of Daily Living and External Rotation (ADLER) score. Secondary outcomes included the Auto-Constant Score (CS), Subjective Shoulder Value (SSV), activities of daily living requiring internal rotation (ADLIR) score, visual analog scale (VAS) for pain, and radiographic analysis of standardized radiographs.

In total, 32 procedures in 32 patients were identified. Of these, 22 procedures in 22 patients (68% female, 72.9 ± 8.4 years at surgery) were available for follow-up at 4.8 ± 2.2 years postoperatively (response rate 73%). The ER lag sign resolved in 95.5% of patients, the active ER improved significantly from -13° (-20-0°) preoperatively to 10° (0-20°) postoperatively (p = 0.002). The ADLER score increased from 20 (18-21.5) to 30 (28-30, p < 0.001). The CS improved from 32 (25-52) to 71 (67-75, p < 0.001) and the SSV from 30 (28-40) to 80 (65-100, p = 0.002), and low pain levels were reported. Internal rotation (p = 1) and the ADLIR score (p = 0.56) did not improve or decrease. No revisions or complications were observed.

rTSA with concomitant isolated LDT resulted in favorable clinical, functional, and radiographic mid-term outcomes, with a high rate of resolved external rotation lag sign and a significant improvement in activities of daily life that require ER. This procedure should be considered a viable treatment option in patients undergoing rTSA with posterior rotator cuff deficiency and an ER lag sign.

IV, retrospective case series.