[Latissimus dorsi transfer in case of irreparable rotator cuff tear--a comparative analysis of primary and failed rotator cuff surgery, in dependence of deficiency grade and additional lesions]. / Latissimus-dorsi-Plastik zur Versorgung irreparabler Rotatorenmanschettenmassendefekte--Eine vergleichende Analyse nach primärer und sekundärer Rekonstruktion in Abhängigkeit vom Ausmass des Rotatorendefektes und zusätzlicher Läsionen.

ABSTRACT

AIM: Latissimus dorsi transfer is a difficult operation with a long rehabilitation. We investigated if it is worth the effort. METHOD: We used this technique in 22 patients with an inoperable rotator cuff tear (15 patients had a primary surgery, 7 patients were operated after failed prior rotator cuff repair). Additional lesions were also considered in the analysis. The average follow up was 9 months. The results were divided in 4 groups severe indication, primary reconstruction, 3-tendon rupture, secondary reconstruction. RESULTS: The best results were achieved by the group "severe indication" (raising in the Constant score from 38 to 79 points). The group with primary surgery (increasing from 43 to 67 points) had better results than the group with failed prior reconstruction (increasing from 33 to 62 points). In case of additional rupture of the subscapularis tendon (45 to 58 points) or insufficiency of the deltoid muscle (33 to 45 points) the results are not satisfactory. The postoperative pain relief was felt as the predominant improvement. CONCLUSION: The latissimus dorsi transfer is a valuable and safely reproducible procedure. Depending on the preoperative grade of deficiency it is possible to achieve a shoulder function of 60-90 % in comparison to the healthy shoulder. Despite the difficult operation technique and the long rehabilitation phase, the LDP is worth the effort on patients with irreparable rotator cuff tears. It is not the right procedure in cases of defect arthropathy--in these cases inverted shoulder prosthesis should be used.