Are there advantages of the combined latissimus-dorsi transfer according to L'Episcopo compared to the isolated latissimus-dorsi transfer according to Herzberg after a mean follow-up of 6 years? A matched-pair analysis

J Shoulder Elbow Surg. 2012 Nov;21(11):1499-507. doi: 10.1016/j.jse.2012.01.002. Epub 2012 Apr 26.


Hypothesis: The aim of the study was to evaluate differences of clinical results between the latissimus-dorsi transfer combined with teres-major transfer (G1) and the isolated latissimus-dorsi transfer (G2) for the treatment of massive irreparable postero-superior rotator cuff tears.

Methods: We performed the combined latissimus-dorsi/teres-major transfer in 17 patients at a mean age of 57 years. Furthermore, 17 patients at a mean age of 61 years were treated using the isolated latissimus-dorsi transfer. Both groups were followed-up clinically, radiologically, and with surface electromyography using the same study protocol.

Results: The Constant score (CS) improved significantly from 48.3 points pre-op to 69.5 points post-op after a follow-up of 58 months in G1. The active range of motion improved in G1 sig. for flexion (124° pre-op, 166.5° post-op) and for abduction (117° pre-op, 163° post-op). The CS improved significantly from 45.1 points pre-op to 74.2 points post-op after a follow-up of 51 months in G2. The flexion and abduction increased significantly from 133.3° pre-op to 176° post-op, resp. from 113.3° pre-op to 173° post-op. The comparison of both surgical techniques showed a significant better active flexion and abduction for G2.

Conclusion: Both techniques achieved good functional results but the isolated latissimus-dorsi transfer produced a better active abduction and flexion, whereas the combined latissmus-dorsi/teres-major transfer achieved an increase in abduction strength. In contrast to the combined latissimus-dorsi/teres-major transfer, a progression of cuff tear arthropathy was not observed with the isolated latissimus-dorsi transfer.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Muscle, Skeletal / transplantation*
  • Prospective Studies
  • Range of Motion, Articular*
  • Rotator Cuff / physiopathology
  • Rotator Cuff / surgery*
  • Rotator Cuff Injuries
  • Rupture
  • Shoulder Injuries
  • Shoulder Joint / physiopathology
  • Shoulder Joint / surgery*
  • Tendon Transfer / methods*
  • Time Factors
  • Treatment Outcome