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Letter regarding article by Clavert et al.: long-term outcomes of latissimus dorsi transfer for irreparable rotator cuff tears
No full textQuality of life and functionality after reverse shoulder arthroplasty
No full textBACKGROUND: Few studies have evaluated at a medium-term follow-up the use of semiconstrained reverse shoulder arthroplasty (RSA) for primary glenohumeral osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy excluding any other shoulder disease. Moreover, data on patients' quality of life after this surgery are lacking.
METHODS: In this prospective cohort study, 80 patients were evaluated after an RSA for either primary osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy with the Constant-Murley score (CMS), ROM, and Short Form Health Survey (SF-36). A radiologic assessment was performed pre- and postoperatively.
RESULTS: At a mean 5-year follow-up, the cumulative survival rate was 97.3% and significant improvements in the CMS and ROM were observed when compared with the baseline values. The CMS was 93.2% of the sex- and age-matched normal values. The postoperative SF-36 scores showed no significant differences compared with normative data. Younger patients and subjects with worse preoperative conditions achieved the greatest benefit after RSA. A 70% scapular notching rate was noted and the length of follow-up was found to be associated with the severity of scapular notching.
CONCLUSIONS: This study introduces new predictors for surgical outcomes, and it shows that patients who had undergone RSA a mean of 5 years earlier exhibit similar functionality and health-related quality of life with respect to healthy controls
Arthroscopic Latarjet procedure: Analysis of the learning curve
No full textBackground: The arthroscopic Latarjet procedure is an innovative technique that aims to combine the optimal results of the original open approach with those of arthroscopic stabilization. Methods: We evaluated the learning curve and the preliminary results of the first 30 patients (29 males, 1 female; mean age 32 years, range 21-52) subjected to an arthroscopic Latarjet procedure at a mean follow-up of 13 months (range 6-22). Results: Operative time fell significantly from 132 to 99 min (p < 0.001, t test) in the last 15 patients compared with the first 15 without significant differences in terms of Rowe score, patient satisfaction, complications, or graft placement. There were 21 (70 %) excellent and 9 (30 %) good outcomes according to the Rowe score. All complications (10 %) correlated with age >40 years (p = 0.002, Fisher's exact test). Conclusions: The arthroscopic Latarjet procedure is a standardized, hence reproducible technique whose complexity makes it suitable only for surgeons with solid experience in arthroscopy and shoulder surgery. © 2013 Istituto Ortopedico Rizzoli
Open latarjet procedure
No full textSince the first description of the Latarjet procedure, more than 60 years have elapsed. However, this surgical technique is still widely used today. The bone block attributable to the coracoid process together with the sling effect performed by the conjoined tendon and the repair of the capsule to the sectioned coracoacromial ligaments represent viable surgical options to treat anteroinferior shoulder instability. Patients with an ISIS score over 6 points or >15% glenoid bone loss represent ideal candidate for this procedure. The Latarjet procedure is a complex and demanding technique, and meticulous surgical technique is recommended to avoid possible complications. The arthroscopic-assisted and the all-arthroscopic Latarjet have been proposed in the past decade to reduce the rate of bone block malpositioning, decrease soft-tissue damage associated with open approach, and possibly decrease intraoperative complications. However, open questions remain unanswered as for the indisputable use of arthroscopy to address this procedure
The 50 Highest Cited Papers on Rotator Cuff Tear
No full textPurpose: The purpose of this study was to determine the 50 most cited articles on rotator cuff tear and their characteristics. Methods: Thomson ISI Web of Science was searched for the following search terms “rotator cuff” and “tear.” The following characteristics were determined for each article: author(s), year of publication, source journal, geographic origin, article type (and subtype), and level of evidence for clinical articles. Results: The number of citations ranged from 1558 to 253. The 50 most often cited articles were published in 7 journals. The majority of the articles (n = 46) were clinical, with the remaining representing some type of basic science research. Among clinical articles, the case series (n = 23) was the most common article subtype. Nine articles were methodologic in that they proposed a new classification/scoring system or technique. The most common level of evidence was Level IV (n = 31). Conclusion: This article provides clinicians, researchers, and trainees with a group of articles that should be taken into consideration as building blocks in the treatment of rotator cuff tears. Level of Evidence: Level IV, literature review
Arthroscopic Latissimus Dorsi Transfer for Massive Irreparable Rotator Cuff Tears
No full textIn massive irreparable rotator cuff tears, at least two tendons are torn, with medial retraction, fatty infiltration, and muscle wasting, resulting in the impossibility to achieve a direct repair of the native tendon to the humerus despite mobilizing the soft tissues. Latissimus dorsi tendon transfer is an effective option for young and active patients with massive irreparable posterosuperior rotator cuff tears and intact subscapularis tendon, showing excellent outcomes on both short- and long-term follow-up. Published reports demonstrated marked pain reduction, associated with an almost complete functional range of motion (ROM), an increase in functional scores, and an overall high rate of patient’s satisfaction. The efficacy of latissimus dorsi tendon transfer relies on two main effects: the tenodesis effect, resisting humeral head migration, and the persistence of muscular activity, allowing the transferred tendon to cope with its new function. The present chapter provides insights into the use of this transfer, covering basic evidence, clinical results, and a step-by-step easy and reproducible surgical technique
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