Abstract
Purpose: To evaluate subjective and objective results of reverse shoulder arthroplasty (RSA) combined with transfer of latissimus dorsi and teres major tendons (modified L’Episcopo transfer) in a large cohort and determine if postoperative improvements were maintained over time. Methods: Fifty-nine consecutive patients were presented to our clinic with a combined loss of active elevation and external rotation (CLEER) and were treated with a combined RSA and modified L’Episcopo transfer. Patients were prospectively followed on a yearly basis. Clinical evaluation and radiographic evaluation were obtained in all patients at each visit. Two patients were unable to return for follow-up, and 1 patient died. Follow-up averaged 44 months (range: 12–111). Thirty-six patients were presented with cuff tear arthropathy, 9 with a failed rotator cuff repair, 5 with a massive rotator cuff tear, 4 with a failed arthroplasty, and 2 with fracture sequelae. Results: Two patients sustained traumatic tears of the transfer (1 following prosthetic instability and 1 following a periprosthetic fracture) and were excluded from the functional analysis. Combined with the three patients lost to follow-up, this left 54 total patients. Age at surgery was 70 years (range: 52–84). SSV was significantly improved from 29 % preoperatively to 72 % postoperatively. Forward flexion improved by an average of 53° and external rotation improved by 28° (−30–70°). The ADLER and adjusted Constant scores improved from 9 preoperatively to 25 postoperatively and from 44 % preoperatively to 88 % postoperatively, respectively, at most recent follow-up. Improvements were maintained over long-term follow-up. Forty-nine patients were very satisfied or satisfied with their surgical result, and 5 patients were disappointed. Conclusion: Combined RSA with modified L’Episcopo transfer is an effective procedure for restoring forward elevation and external rotation in patients presenting with a combined deficit. Subjective and objective improvements are realized soon after surgery and are maintained with time.
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Gauci, MO. et al. (2016). Massive Irreparable Rotator Cuff Tears: How to Rebalance the Cuff-Deficient Shoulder?. In: Frankle, M., Marberry, S., Pupello, D. (eds) Reverse Shoulder Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-20840-4_26
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DOI: https://doi.org/10.1007/978-3-319-20840-4_26
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