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International Orthopaedics

, Volume 38, Issue 3, pp 553–559 | Cite as

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

  • Reinhold Ortmaier
  • Herbert Resch
  • Wolfgang Hitzl
  • Michael Mayer
  • Martina Blocher
  • Imre Vasvary
  • Georg Mattiassich
  • Ottokar Stundner
  • Mark Tauber
Original Paper

Abstract

Purpose

Reverse shoulder arthroplasty (RSA) can restore active elevation in rotator-cuff-deficient shoulders. However, RSA cannot restore active external rotation. The combination of latissimus dorsi transfer with RSA has been reported to restore both active elevation and external rotation. We hypothesised that in the combined procedure, harvesting the latissimus dorsi with a small piece of bone, leads to good tendon integrity, low rupture rates and good clinical outcome.

Methods

Between 2004 and 2010, 13 patients (13 shoulders) were treated with RSA in combination with latissimus dorsi transfer in a modified manner. The mean follow-up was 65.4 months, and the mean age at index surgery was 71.1 years. All patients had external rotation lag sign and positive hornblower’s sign, as well as radiological signs of cuff-tear arthropathy (Hamada 3, 4 or 5) and fatty infiltration grade 3 according to Goutallier et al. on magnetic resonance imaging (MRI). The outcome measures included the Constant Murley Score, University of California-Los Angeles (UCLA) shoulder score, Simple Shoulder Test (SST), visual analogue scale (VAS) and the Activities of Daily Living Requiring External Rotation (ADLER) score. Tendon integrity was evaluated with dynamic ultrasound. All patients were asked at final follow-up to rate their satisfaction as excellent, good, satisfied or dissatisfied.

Results

The overall mean Constant-Murley Shoulder Outcome Score (CMS) improved from 20.4 to 64.3 points (p < 0.001). Mean VAS pain score decreased from 6.8 to 1.1 (p < 0.001)., mean UCLA score improved from 7.9 to 26.4 (p < 0.001), mean SST score improved from 2.3 to 7.9 (p < 0.001) and mean postoperative ADLER score was 26 points. The average degree of abduction improved from 45° to 129° (p < 0.001), the average degree of anterior flexion improved from 55° to 138° (p < 0.001) and the average degree of external rotation improved from −16° to 21° (p < 0.001). Eight patients rated their results as very satisfied, three as satisfied and two as dissatisfied.

Conclusion

This modified technique, which avoids cutting the pectoralis major tendon and involves harvesting the tendon together with a small piece of bone, leads to good or even better functional results compared with the results reported in the literature, and also has high patient satisfaction and low failure rates.

Keywords

Reverse shoulder arthroplasty Latissimus dorsi transfer External rotation Bone-chip technique 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Reinhold Ortmaier
    • 1
  • Herbert Resch
    • 1
  • Wolfgang Hitzl
    • 2
  • Michael Mayer
    • 3
  • Martina Blocher
    • 1
  • Imre Vasvary
    • 4
  • Georg Mattiassich
    • 5
  • Ottokar Stundner
    • 6
  • Mark Tauber
    • 7
  1. 1.Department of Traumatology and Sports InjuriesParacelsus Medical UniversitySalzburgAustria
  2. 2.Department of BiostatisticsParacelsus Medical UniversitySalzburgAustria
  3. 3.Department of Spine Surgery Werner-Wicker Klinik and Paracelsus Medical UniversityBad WildungenGermany
  4. 4.Department of RadiologyParacelsus Medical UniversitySalzburgAustria
  5. 5.Department of Traumatology UKH LinzTeaching Hospital of the Paracelsus Medical UniverstityLinzAustria
  6. 6.Department of AnaesthesiologyParacelsus Medical UniversitySalzburgAustria
  7. 7.Paracelsus Medical University and Shoulder and Elbow Service ATOS Clinic MunichMünchenGermany

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