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Allograft-enhanced latissimus dorsi transfer is better than the conventional technique for irreparable posterosuperior rotator cuff tears. A retrospective matched cohort

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Abstract

Purpose

Latissimus dorsi tendon (LDT) transfer (LDTT) to the greater tuberosity to treat irreparable posterosuperior rotator cuff tears (RCTs) in young active patients has been shown to have up to 36% of clinical failures, most of them happening because of either deltoid origin disruption or post-operative transfer rupture from the greater tuberosity. In an attempt to simultaneously prevent both complications, a modified technique includes the following adaptations to the original technique: reinforcement and augmentation of the LDT with a tendinous allograft, enabling the use of a single deltopectoral approach. The aim of this study is to compare mid-term outcomes of the traditional LDTT technique with this modified transfer.

Methods

Retrospective cohort study comparing two groups who underwent either the traditional (group 1; n = 19) or the modified technique (group 2; n = 27). Group homogenization was assured by statistical comparison of 24 baseline independent variables. The outcome variables were the gains to active shoulder range of motions (ROM) and UCLA scores (and all its subscores, independently), at a minimum follow-up of two years. A p value < .05 was considered to be statistically significant.

Results

At a mean follow-up of 25 months, both groups have shown improvements to most variables. However, group two (modified technique) achieved greater improvements to UCLA score (p = .009), active external rotation (p = .006) and internal rotation (p = .008).

Conclusion

At mid-term follow-up, improvements to outcomes of the modified (single approach, allograft-enhanced) latissimus dorsi transfer were greater than those of the original technique.

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Data availability

The authors affirm that all material, data and software application used in the making of this study support our published claims and comply with field standards. The data in this study is original and has not been re-used from other published or unpublished material.

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Acknowledgements

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil

    Caio Santos Checchia, Luciana Andrade da Silva, Guilherme do Val Sella, Sergio Luiz Checchia, Patrícia Maria de Moraes Barros Fucs & Alberto Naoki Miyazaki

  2. Hospital Sírio-Libanês, São Paulo, Brazil

    Caio Santos Checchia & Sergio Luiz Checchia

  3. Hospital Alemão Oswaldo Cruz, São Paulo, Brazil

    Alberto Naoki Miyazaki

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  4. Sergio Luiz Checchia
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Caio Santos Checchia. The first draft of the manuscript was written by Caio Santos Checchia and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Caio Santos Checchia.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of “Comitê de Ética em Pesquisa da Irmandade da Santa Casa de Misericórdia de São Paulo" under the approval number “CAAE 08077319.0.0000.5479”.

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1b, 2b, 3 and 4b.

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Checchia, C.S., da Silva, L.A., do Val Sella, G. et al. Allograft-enhanced latissimus dorsi transfer is better than the conventional technique for irreparable posterosuperior rotator cuff tears. A retrospective matched cohort. International Orthopaedics (SICOT) 47, 1527–1534 (2023). https://doi.org/10.1007/s00264-023-05775-0

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