Teres major tendon transfer in the treatment of irreparable posterosuperior rotator cuff tears: long-term improvement of shoulder function and pain reduction at eight to 12 years' follow-up.

Aims: Since long-term outcome of teres major tendon transfer surgery for irreparable posterosuperior rotator cuff (RC) tears is largely unknown, the primary aim of this study was to evaluate the long-term outcome of the teres major transfer. We also aimed to report on the results of a cohort of patients with a similar indication for surgery that underwent a latissimus dorsi tendon transfer. Patients and Methods: Patients and Methods In this prospective cohort study, we reported on the long-term results of 20 consecutive patients with a teres major tendon transfer for irreparable massive posterosuperior RC tears. Additionally, we reported on the results of the latissimus dorsi tendon transfer (n = 19). The mean age was 60 years (47 to 77). Outcomes included the Constant score (CS), and pain at rest and during movement using the Visual Analogue Scale (VAS). Results: At a mean of ten years (8 to 12) following teres major transfer, the CS was still 23 points (95% confidence interval (CI) 14.6 to 30.9, p < 0.001) higher than preoperatively. VAS for pain at rest (21 mm, 95% CI 4.0 to 38.9, p = 0.016) and movement (31 mm, 95% CI 16.0 to 45.1, p < 0.001) were lower than preoperatively. We also found an increase in CS (32 points, 95% CI 23.4 to 40.2, p < 0.001) and reduction of pain (26 mm, 95% CI 9.9 to 41.8, p = 0.001) six years after latissimus dorsi transfer. Conclusion: Teres major tendon transfer is a treatment option to gain shoulder function and reduce pain in patients with an irreparable posterosuperior RC tear at a mean follow-up of ten years. The teres major tendon might be a valuable alternative to the commonly performed latissimus dorsi tendon transfer in the treatment of irreparable posterosuperior RC tears. Cite this article: Bone Joint J 2018;100-B:309-17.

Use of sutures as Kirschner wire and tension-band wire for olecranon fractures: a technical note.

Open reduction and internal fixation using tension-band wires for displaced olecranon fractures enables restoration of extensor function. We report on 3 elderly patients with a displaced olecranon fracture who underwent open reduction and internal fixation using sutures as the Kirschner wire and tension-band wire and achieved good outcome.

Cranial humerus translation, deltoid activation, adductor co-activation and rotator cuff disease - different patterns in rotator cuff tears, subacromial impingement and controls.

BACKGROUND: Arm adductor co-activation during abduction has been reported as a potential compensation mechanism for a narrow subacromial space in patients with rotator cuff dysfunction. We assessed differences in acromiohumeral distance at rest and the amount of humerus translation during active abduction and adduction in patients with rotator cuff tears (n=20) and impingement (n=30) and controls (n=10), controlled for deltoid, pectoralis major, latissimus dorsi and teres major activation (electromyography). METHODS: During the acquirement of shoulder radiographs, subjects performed standardized isometric arm abduction and adduction tasks. EMG's were normalized between -1 and 1 using the "Activation Ratio", where low values express (pathologic) co-activation, e.g. adductor activation during abduction. FINDINGS: In patients with cuff tears mean rest acromiohumeral distance was 7.6mm (SD=1.6): 3.5mm narrower compared to patients with impingement (95%-CI: 2.4-4.5) and 1.3mm narrower compared to controls (95%-CI: -0.1-2.7). Both during abduction and adduction tasks, cranial translation was observed with equal magnitudes for patients and controls, with average values of 2.3 and 1.7mm, respectively. Where patients with cuff tears had lower adductor Activation Ratios (i.e. more adductor co-activation during abduction), no association between abductor/adductor muscle activation and acromiohumeral distance was found. INTERPRETATION: The subacromial space is narrower in patients with rotator cuff tears compared to patients with impingement and controls. We found additional subacromial narrowing during isometric abduction and, to a lesser amount, during adduction in all subjects and more adductor co-activation in patients with cuff tears. We found no association between subacromial space and activation of the deltoid and main adductors.

Cranial translation of the humeral head on radiographs in rotator cuff tear patients: the modified active abduction view.

Cranial translation of the humeral head is related to massive rotator cuff tears; however, it may be unapparent in early-stage tears. The goal of this study was to investigate whether active abduction leads to increased active cranial humeral translation in early-stage tears. We assessed 20 consecutive patients (9 full-thickness supraspinatus tears, 11 posterosuperior tears) using the newly introduced modified active abduction view: acromiohumeral (AH) distance was measured on radiographs acquired during rest and active isometric abduction and adduction tasks with the arm alongside the body. Rest AH was 7.5 mm (SD = 1.53); during abduction and adduction, it decreased to 2.1 mm (95 % CI 1.28-3.01, p < 0.001) and 1.1 mm (95 % CI 0.46-1.65, p = 0.001), respectively. Cranial translation during abduction was more severe in shoulders with posterosuperior cuff tears (∆AH = 3 mm, SD = 1.5) compared to supraspinatus tears (∆AH = 1 mm, SD = 1.6), with a mean difference of 2 mm (95 % CI 0.64-3.58, p = 0.007). Both active isometric abduction and adduction leads to active cranial translation in cuff tear patients. Cranial translation is largest during active abduction. Furthermore, there is significant more cranial translation in posterosuperior cuff tear patients compared to supraspinatus cuff tear patients. Possibly, radiographs combined with active tasks offer new possibilities in diagnosing early-stage rotator cuff tears.

Teres major tendon transfer for patients with massive irreparable posterosuperior rotator cuff tears: Short-term clinical results.

Surgical repair of posterosuperior rotator cuff tears has a poorer outcome and a higher rate of failure compared with repairs of supraspinatus tears. In this prospective cohort study 28 consecutive patients with an irreparable posterosuperior rotator cuff tear after failed conservative or surgical treatment underwent teres major tendon transfer. Their mean age was 60 years (48 to 71) and the mean follow-up was 25 months (12 to 80). The mean active abduction improved from 79° (0° to 150°) pre-operatively to 105° (20° to 180°) post-operatively (p = 0.011). The mean active external rotation in 90° abduction improved from 25° (0° to 70°) pre-operatively to 55° (0° to 90°) post-operatively (p < 0.001). The mean Constant score improved from 43 (18 to 78) pre-operatively to 65 (30 to 86) post-operatively (p < 0.001). The median post-operative VAS (0 to 100) for pain decreased from 63 (0 to 96) pre-operatively to 5 (0 to 56) post-operatively (p < 0.001). In conclusion, teres major transfer effectively restores function and relieves pain in patients with irreparable posterosuperior rotator cuff tears and leads to an overall clinical improvement in a relatively young and active patient group with limited treatment options.