Association of Arthroscopically-Assisted Latissimus Dorsi Tendon Transfer with Implantation of a Subacromial Balloon Spacer for Patients with Irreparable Posterosuperior Rotator Cuff Tears

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Purpose. Massive irreparable posterosuperior rotator cuff tears in an active population, resulting in a pseudo-paralytic shoulder, pose a challenge for the orthopaedic surgeon. In an effort to avoid or delay arthroplasty surgery, other surgical strategies such as arthroscopically-assisted latissimus dorsi transfer (aLDT) or the implantation of a subacromial spacer (SAS) can be considered. The aim of the present study is to associate, for the first time, these two surgical procedures in order to demonstrate the surgical feasibility and the effectiveness of their synergistic biomechanical effect. Methods. The study group consisted of patients who underwent aLDT for a massive irreparable posterosuperior rotator cuff tear with or without SAS placement. The study population consisted of 17 patients. Patients were assessed with the following outcomes scores: Constant and Murley Score (CMS), Disability of Arm, Shoulder and Hand (DASH), Oxford Shoulder Score (OSS), and Subjective Shoulder Value (SSV). Follow-up after surgery (T0) took place at the following time points: 40 days (T1), 3 months (T2), 9 months (T3), and 12 months (T4). Statistical analysis was performed by descriptive statistics, nonparametric ANOVA test, and a multivariate linear regression model. The effect of subscapularis repair on clinical outcomes was also examined with subgroup analysis. Results. In the entire population, the mean change in scores between T0 and T4 was: +30.5 for CMS, -35.14 for DASH, +18.06 for OSS, +40.47 for SSV. A statistically significant increase in all scores for both aLDT alone and aLDT with concomitant SAS was detected starting as early as T2. The subscapularis repair group had the following results as compared with the subscapularis intact group: CMS -9.5580 (p = 0.0164), OSS -5.6873 (p = 0.0378), and DASH +21.0424 (p = 0.0097). Conclusions. This study demonstrates, for the first time, the feasibility and efficacy of the arthroscopically-assisted latissimus dorsi transfer alone and with concomitant implantation of a subacromial spacer. Both surgeries demonstrate clinical efficacy as early as three months after surgery, with significant and progressive clinical improvements through 12 months postoperatively.

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