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Combined Fully Arthroscopic Transfer of Latissimus Dorsi and Teres Major for Treatment of Irreparable Posterosuperior Rotator Cuff Tears.

ABSTRACT: Many treatment options have been proposed for treatment of irreparable posterosuperior rotator cuff tears. Among these options, latissimus dorsi tendon transfer can be considered a good alternative, especially in young patients before development of glenohumeral arthritic changes, aiming at rebalancing the shoulder with a functioning subscapularis muscle and restoring both active external rotation and elevation with the aid of a properly functioning deltoid muscle. The technique was recently adapted from open to arthroscopically assisted with numerous advantages. We propose a combined fully arthroscopic technique for transfer of latissimus dorsi and teres major in which the tendons are fixed in a flat manner at the junction of supraspinatus and infraspinatus to decrease failure rate.

SUBMITTER: Kany J

PROVIDER: S-EPMC6993265 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Technical Guide and Tips to Posterior Arthroscopic Latissimus Dorsi Transfer for Irreparable Posterosuperior Rotator Cuff Tears.

Project description:Latissimus dorsi (LD) transfer is a reliable treatment option for irreparable posterosuperior (PS) rotator cuff tears in young and active patients that need to recover the range of motion for their daily living activities. The technique starts with an arthroscopic assessment of the tear. The next step is the mini-open stage for muscle release from the subcutaneous layer of the skin, the teres major (TM), the triceps, and the lateral border and inferior angle of the scapula. Later, the scope is used to prepare the footprint (arthroscopy) and for the release and the harvest of the tendon (endoscopy), taking care not to detach the TM and not to damage the radial nerve. A grasper is used to push the LD to its correct path medial to the triceps. After that the same instrument is placed from the anterolateral and the anterior arthroscopic portals toward the mini-open incision to catch the sutures previously loaded on the LD tendon with Krackow stitches. The LD is transferred to the greater tuberosity and is attached with one medial and one lateral knotless anchors. A third point of fixation enables a partial RC repair and ensures a surface of bone to tendon healing.

| S-EPMC9134106 | biostudies-literature

Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique using arthroscopy.

Project description:Latissimus dorsi transfer is a well-established method for the treatment of posterosuperior massive irreparable rotator cuff tears. We propose using an arthroscopically assisted technique that avoids insult to the deltoid. With the patient in the lateral decubitus position, an L-shaped incision is made along the anterior belly of the latissimus muscle and then along the posterior axillary line. The latissimus and teres major are identified and separated. The tendon insertion of the latissimus is isolated, and a FiberWire traction suture (Arthrex, Naples, FL) is placed, facilitating dissection of the muscle to the thoracodorsal neurovascular pedicle and subsequent mobilization. The interval deep to the deltoid and superficial to the teres minor is developed into a subdeltoid tunnel for arthroscopic tendon transfer. The latissimus tendon is then transferred and stabilized arthroscopically to the lateral aspect of the infraspinatus and supraspinatus footprints by multiple suture anchors.

| S-EPMC3678602 | biostudies-literature

Arthroscopic-Assisted Anterior Latissimus Dorsi Transfer for Irreparable Anterior Rotator Cuff Tear: A Technical Note.

Project description:Several reconstruction techniques for irreparable tears of the subscapularis tendon have been described with variable results regarding pain relief, functional recovery, and dynamic stabilization of the glenohumeral joint. Because of a more advantageous direction of movement compared with previously described transfer techniques such as transfer of the pectoralis major and pectoralis minor tendons, the anterior latissimus dorsi (LD) transfer has been proposed as a potentially beneficial treatment method. This Technical Note aims to introduce an alternative technique for the anterior LD transfer that combines the advantages of a proper muscle release and tendon reinforcement through an axillary incision with the arthroscopic intra-articular and periarticular work, including detachment of the LD tendon from its humeral insertion and reattachment at the lesser tuberosity.

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Subacromial Balloon Implantation for the Treatment of Irreparable Posterosuperior Rotator Cuff Tears

Project description:Despite the development of various therapeutic options, surgical management of irreparable rotator cuff tears (IRCTs) remains controversial. Recently, implantation of a biodegradable subacromial balloon spacer (InSpace, Stryker Corporation; Kalamazoo, MI) has gained considerable interest for the treatment of certain IRCTs. The reported outcome of balloon implantation has not been consistent, likely due to differing indications and technical approaches. The purpose of this article is to present a reproducible arthroscopic technique for implantation of a subacromial balloon and to review the literature published to date, regarding the efficacy and outcomes of this procedure. Technique Video Video 1 Detailed surgical steps of the technique described with a voiceover. The video demonstrates an arthroscopic technique for implantation of a subacromial balloon spacer (InSpace, Stryker Corporation, Kalamazoo, MI). The patient is in the beach chair position with a right-sided operative shoulder. The primary viewing portal is posterior, and the main working portal is lateral. After a routine diagnostic arthroscopy, the subacromial space is prepared with an arthroscopic shaver. The balloon is then sized and implanted through the lateral portal under direct visualization from the posterior portal. Finally, the subacromial balloon spacer (InSpace, Stryker Corporation) system is again highlighted.

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Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears.

Project description:Massive irreparable rotator cuff tears in young patients are a particular challenge for the orthopaedic surgeon. Surgical treatment options include debridement, partial rotator cuff repair, patch-augmented rotator cuff repair, bridging rotator cuff reconstruction with graft interposition, tendon transfer, and reverse total shoulder arthroplasty. Recently, reconstruction of the superior glenohumeral capsule using a fascia lata autograft has been suggested to reduce superior glenohumeral translation and restore superior stability. Promising clinical results have been reported in 1 case series of 23 patients, indicating that superior capsular reconstruction may be a promising tool to manage massive irreparable rotator cuff tears. This article describes our preferred technique for arthroscopic superior capsule reconstruction.

| S-EPMC4886263 | biostudies-literature

Arthroscopic Partial Repair of Irreparable, Massive Rotator Cuff Tears.

Project description:Several treatment options for chronic, massive rotator cuff tears exist, and they include debridement with possible biceps tenotomy or tenodesis, open or arthroscopic partial repair, muscle or tendon transfer, superior capsule reconstruction, synthetic patch augmentation, and reverse total shoulder arthroplasty. The aim of this technique article is to describe our preferred surgical option for irreparable, massive rotator cuff tears with an irreparable supraspinatus, a reparable infraspinatus, and an intact or reparable subscapularis tendon.

| S-EPMC5368352 | biostudies-literature

Latissimus Dorsi Tendon Transfer With Acromial Osteotomy for Massive Irreparable Rotator Cuff Tear.

Project description:Latissimus dorsi tendon transfer is an effective option for young and active patients with massive irreparable posterosuperior rotator cuff tears and intact subscapularis tendon. This approach has been shown to relieve pain and improve shoulder function in both the short and long term. We describe a surgical technique using an acromial osteotomy to better expose the greater tuberosity for the tendon transfer without disrupting the deltoid muscle. The latissimus dorsi tendon is reinforced with a human dermal collagen matrix (GraftJacket; Wright Medical Group) for additional augmentation of the muscle to gain more excursion for the tendon transfer to the greater tuberosity. The transferred tendon is fixed to the supraspinatus and infraspinatus footprints on the greater tuberosity using suture anchors. The acromial osteotomy is repaired back anatomically with several No. 5 braided sutures (FiberWire; Arthrex).

| S-EPMC5850886 | biostudies-literature

Arthroscopic-Assisted Lower Trapezius Tendon Transfer for Massive Irreparable Posterosuperior Rotator Cuff Tears Using an Achilles Tendon-Bone Allograft.

Project description:The lower trapezius tendon (LTT) transfer has been described for the management of irreparable posterosuperior rotator cuff tears. Here we describe our technique of an arthroscopic-assisted LTT transfer using an Achilles tendon-bone allograft. This technique allows for augmentation of the tendon transfer using an Achilles tendon allograft while also keeping the calcaneal bone insertion, which allows for added bony fixation into the humerus and also minimizing the risk of the "killer turn" phenomenon at the aperture of fixation.

| S-EPMC7695616 | biostudies-literature

Technical Guide and Tips to Anterior Arthroscopic Latissimus Dorsi Transfer for Irreparable Subscapularis Tears.

Project description:In young patients, irreparable subscapularis tears can be managed by latissimus dorsi (LD) transfer on the lesser tuberosity. We provide a technical guide for isolated LD anterior transfer. The surgical procedure begins with glenohumeral exploration and release of the remaining subscapularis. Then, we dissect the LD tendon below the subscapularis. At the upper and inferior borders, we dissect the LD from the teres major, protecting the radial nerve anteriorly and inferiorly. Next, we detach the LD. Inferiorly, we cut the aponeurotic expansion for the triceps. A Foley catheter is used as a shuttle relay, anterior to the axillary nerve and medial and posterior to the radial nerve. We continue with an open dissection of the LD, posterior to the axillary fossa, to release the LD from the skin and tip of the scapula. The LD is transferred on the lesser tuberosity after retrieved by the Foley catheter, with care taken not to twist the tendon. It is fixed with 2 lateral anchors and 1 medial anchor. A shoulder brace is worn for 6 weeks. Physiotherapy begins thereafter.

| S-EPMC7695617 | biostudies-literature

Arthroscopic Single-Row Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears.

Project description:Massive, irreparable rotator cuff tears are challenging to manage. Often, these tears are not amenable to primary repair and necessitate additional treatment options. This is especially true in patients with absent glenohumeral arthritis in the setting of a massive, irreparable rotator cuff tear. Superior capsular reconstruction (SCR), originally described by Mihata using a fascia lata autograft, has grown in popularity for the treatment of irreparable rotator cuff tears as a salvage option with good clinical outcomes. More recently, SCR techniques have been described using dermal allograft. Biomechanical studies and reported clinical series show promising results, with favorable postoperative clinical outcomes. The procedure, however, may be technically challenging, especially when performed using an all-arthroscopic technique. This article describes an all-arthroscopic technique using a predetermined graft size, unique medial fixation to ease graft passage, and knotless single-row lateral fixation to optimize suture management and efficiency.

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