Abstract
Purpose
The objective of this study was to evaluate the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) associated with two techniques: L’Episcopo procedure (combined teres major and latissimus dorsi transfer) and modified L’Episcopo procedure (isolated latissimus dorsi transfer).
Methods
A retrospective review of 36 RSAs (mean age 69.8 years; SD 8.9) associated with either L’Episcopo procedure (Group 1, 21 cases) or modified L’Episcopo procedure (Group 2, 15 cases) was performed between 2007 and 2020. Clinical outcome measures consisted of range of motion (ROM), SSV, VAS, and Constant-Murley scores. These scores were compared between the two groups. Radiographs were assessed for transfer site bony lesions.
Results
With a mean follow-up of 40.8 months (6–98; SD 28.8), no significant differences were revealed in the clinical outcomes: Constant score, SSV, VAS, ROM. The entire study group demonstrated a significant improvement in post-operative functional outcome scores and ROM parameters compared to their pre-operative state, IR measures being the only exception (p = 0.26). Radiographs demonstrated transfer site bony lesions in 60% of the patients (18/30). Three complications (8.3%) were noted in the study.
Conclusion
At the short-term follow-up, RSA combined with either latissimus dorsi (LD) transfer in isolation or in association with teres major proved to be equally effective in restoring external rotation in the settings of an irreparable postero-superior cuff tear treated with RSA. Although the LD transfer group displayed a tendency towards superior ROM, this was not supported statistically. Post-operative radiographs confirmed the presence of bony lesions at the transfer fixation sites in both groups of patients (52% vs. 72%).
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This study was classified as observational (non-interventional) by our local ethics committee Statutory and ethical obligations of observational (non-interventional) studies in France: According to the past Huriet law on biomedical research, and to the current regulation that went into effect in August 2006 (law n°2004–806), such studies do not require prior submission or approval to/from an IRB, and they do not require written consent. There is a current discrepancy on observational studies between the French legal requirements and the editors’ requirements. This observational research on data fulfils current French regulatory and ethical obligations.
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Philippe Valenti and Brian A. Schofield receive royalties for shoulder prosthesis design from FH Orthopedics. All other authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.
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Kazum, E., Martinez-Catalan, N., Caruso, G. et al. Reverse shoulder arthroplasty with isolated latissimus dorsi or combined with teres major transfer for lack of external rotation: a comparative study. International Orthopaedics (SICOT) 46, 2273–2281 (2022). https://doi.org/10.1007/s00264-022-05530-x
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DOI: https://doi.org/10.1007/s00264-022-05530-x