Graft-Augmented Repair of Irreparable Massive Rotator Cuff Tears with Latissimus Dorsi Transfer to Treat Pseudoparesis

Background: Irreparable massive rotator cuff tears are characterized by a poor prognosis with high failure rates following repair. Numerous strategies, such as partial repair, graft interposition, latissimus dorsi (LD) transfer, balloon arthroplasty, and superior capsular reconstruction, have been proposed. We have adopted a graft-augmented LD-transfer procedure, in which partial repair, graft interposition, and LD transfer are performed simultaneously.Methods: Thirty-nine patients underwent the graft-augmented LD-transfer procedure using autologous fascia lata from 2007 to 2016. All patients underwent a 5-year assessment at a mean (and standard deviation) of 54.8 +/- 3.5 months. Of 20 patients with a history of >10 years, 14 underwent a 10-year assessment at a mean of 112.6 +/- 5.6 months. To characterize the therapeutic effects of the procedure, the patients were divided into 3 groups according to the tear pattern: superior-posterior tears (Group A), superior-anterior tears (Group B), and global tears (Group C).Results: The overall mean Constant-Murley score improved from 33.8 +/- 5.3 preoperatively to 63.1 +/- 9.4 at the 5-year assessment (p < 0.001). The overall mean active anterior elevation (AE) improved from 57.3 degrees +/- 13.2 degrees preoperatively to 131.3 degrees +/- 18.2 degrees at 5 years (p < 0.001). Preoperatively, AE was significantly different between Groups A and C (p < 0.001) and between Groups B and C (p < 0.001), reflecting the difference in cuff tear patterns. Postoperatively, AE was significantly higher in Group A than in Groups B (p < 0.001) and C (p < 0.001). The present study also showed that AE was electromyographically synchronized to the contraction of the transferred LD. The transferred LD was kinetically more potent at a slower speed, but it was easier to exhaust, than the native rotator cuff. Osteoarthritis progression was radiographically found to occur during the first 5 years.Conclusions: The graft-augmented LD-transfer procedure may be a treatment option for massive rotator cuff tears, especially for active patients who are <60 years old.