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Revision of a Failed Latissimus Dorsi Transfer for a Massive Rotator Cuff Tear With Arthroscopic Anatomic Bridging Reconstruction Using an Acellular Human Dermal Matrix Allograft.

ABSTRACT: Latissimus dorsi tendon transfer is a nonanatomic tendon transfer that is often considered a salvage procedure for failed repairs of massive rotator cuff tears. A rupture of the transferred latissimus tendon is an uncommon complication and there is limited literature on its management, especially in the young, active population without cuff arthropathy. In this article, we present a technique of managing a failed latissimus dorsi tendon transfer for a massive rotator cuff tear with an arthroscopic, anatomic bridging reconstruction using an acellular human dermal matrix allograft.

SUBMITTER: John R

PROVIDER: S-EPMC6950775 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Revision of a Failed Latissimus Dorsi Transfer for a Massive Rotator Cuff Tear With Arthroscopic Anatomic Bridging Reconstruction Using an Acellular Human Dermal Matrix Allograft.

John Rakesh R Coady Catherine M CM Wong Ivan I

Arthroscopy techniques 20190919 10

Latissimus dorsi tendon transfer is a nonanatomic tendon transfer that is often considered a salvage procedure for failed repairs of massive rotator cuff tears. A rupture of the transferred latissimus tendon is an uncommon complication and there is limited literature on its management, especially in the young, active population without cuff arthropathy. In this article, we present a technique of managing a failed latissimus dorsi tendon transfer for a massive rotator cuff tear with an arthroscop ...[more]

PMID: 31921592

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Project description:Myosteatosis is the pathological accumulation of lipid that occurs in conjunction with atrophy and fibrosis following skeletal muscle injury or disease. Little is known about the mechanisms by which lipid accumulates in myosteatosis, but many studies have demonstrated the degree of lipid infiltration negatively correlates with muscle function and regeneration. Our goal was to identify biochemical pathways that lead to muscle dysfunction and lipid accumulation in injured rotator cuff muscles, a model that demonstrates severe myosteatosis. Adult rats were subjected to a massive tear to the rotator cuff musculature. After a period of either 0 (healthy control), 10, 30, or 60 days, muscles were prepared for RNA sequencing, shotgun lipidomics, metabolomics, biochemical measures, electron microscopy, and muscle fiber contractility. Following rotator cuff injury, there was a decrease in muscle fiber specific force production that was lowest at 30d. There was a dramatic time dependent increase in triacylglyceride content. Interestingly, genes related to not only triacylglyceride synthesis, but also lipid oxidation were largely downregulated over time. Using bioinformatics techniques, we identified that biochemical pathways related to mitochondrial dysfunction and reactive oxygen species were considerably increased in muscles with myosteatosis. Long chain acyl-carnitines and L-carnitine, precursors to beta-oxidation, were depleted following rotator cuff tear. Electron micrographs showed injured muscles displayed large lipid droplets within mitochondria at early time points, and an accumulation of peripheral segment mitochondria at all time points. Several markers of oxidative stress were elevated following rotator cuff tear. The results from this study suggest that the accumulation of lipid in myosteatosis is not a result of canonical lipid synthesis, but occurs due to decreased lipid oxidation in mitochondria. A failure in lipid utilization by mitochondria would ultimately cause an accumulation of lipid even in the absence of increased synthesis. Further study will identify whether this process is required for the onset of myosteatosis.

Project description:BackgroundTendon transfers of the latissimus dorsi transfer (LDT) or the lower trapezius transfer (LTT) are treatment options for irreparable posterosuperior irreparable rotator cuff tears (PSIRCT). There is still no consensus on which type of tendon transfer is superior in the treatment of PSIRCT. Due to the differences in the anatomy and biomechanics, we hypothesize that there are different clinical situations in which either LDT or LTT should be preferred. The aim of this study was to evaluate the clinical and radiological outcomes of LDT and LTT in patients with PSIRCT to establish a clinical algorithm for the treatment decision.Materials and methodsThis is a retrospective, single-center observational study. Included were patients who underwent arthroscopically assisted LDT (aaLDT) or arthroscopically assisted LTT (aaLTT) for PSIRCT. In all patients, range of motion (ROM), external rotation strength, visual analog scale of pain and subjective shoulder value were determined pre- and postoperatively. Constant-Murley score was evaluated at the final follow-up. The complication rate, failure of the tendon transfer, and revision rate were analyzed.ResultsIn total, 29 aaLDT (age 64 years, median follow-up time 45 months) and 8 aaLTT (age 54 years, median follow-up time 34 months) were included. Active ROM, visual analog scale and subjective shoulder value was significantly improved in both cohorts. At follow-up, the median Constant-Murley score was 73 (aaLDT) and 77 (aaLTT), respectively. The failure rate, including revision surgery, was 14% (aaLDT) and 13% (aaLTT), respectively. Low functional findings preoperatively were correlated to a lower functional outcome at follow-up in both groups. Painful loss of anterior elevation and loss of external rotation had no significant impact on functional outcomes in aaLDT.ConclusionFollowing the treatment algorithm based on the clinical examination, clinical outcome parameters, active ROM and pain could be significantly improved. A good preoperative function was associated with a good clinical outcome in both transfers. A low failure and revision rate supports the good decision-making of the algorithm presented.

Dataset Information

Revision of a Failed Latissimus Dorsi Transfer for a Massive Rotator Cuff Tear With Arthroscopic Anatomic Bridging Reconstruction Using an Acellular Human Dermal Matrix Allograft.

Publications

Revision of a Failed Latissimus Dorsi Transfer for a Massive Rotator Cuff Tear With Arthroscopic Anatomic Bridging Reconstruction Using an Acellular Human Dermal Matrix Allograft.

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