Biomechanical analysis of latissimus dorsi tendon transfer with and without superior capsule reconstruction using dermal allograft

Reza Omid; Michael A Stone; Charles C Lin; Nilay A Patel; Yasuo Itami; Michelle H McGarry; Thay Q Lee

doi:10.1016/j.jse.2019.01.016

Biomechanical analysis of latissimus dorsi tendon transfer with and without superior capsule reconstruction using dermal allograft

J Shoulder Elbow Surg. 2019 Aug;28(8):1523-1530. doi: 10.1016/j.jse.2019.01.016. Epub 2019 Apr 24.

Authors

Reza Omid¹, Michael A Stone², Charles C Lin³, Nilay A Patel⁴, Yasuo Itami⁵, Michelle H McGarry⁶, Thay Q Lee⁶

Affiliations

¹ Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
² Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: michaelstone55@gmail.com.
³ University of California Irvine, School of Medicine, Irvine, CA, USA; Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.
⁴ Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA; Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA, USA.
⁵ Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA; Department of Orthopaedic Surgery, Osaka Medical College, Takatsuki, Japan.
⁶ Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.

PMID: 31029520
DOI: 10.1016/j.jse.2019.01.016

Abstract

Background: Irreparable rotator cuff tears (ICTs) remain a challenging treatment dilemma. Superior capsule reconstruction (SCR) acts as a static stabilizer to decrease superior humeral head migration. Latissimus dorsi tendon transfers (LDTs) dynamically decrease superior humeral head migration and improve external rotation. We hypothesized that the dynamic stabilizing effect of the latissimus transfer plus the static stabilizing effect of SCR would improve shoulder kinematics in shoulders with ICTs.

Materials and methods: Eight fresh-frozen cadaveric shoulders were tested in 5 conditions: (1) intact, (2) ICT (supraspinatus plus anterior half of infraspinatus), (3) SCR with dermal allograft, (4) SCR plus LDT, and (5) LDT alone. Rotational range of motion, superior translation, anteroposterior translation, and peak subacromial contact pressure were measured at 0°, 30°, and 60° of glenohumeral abduction in the scapular plane. Statistical analysis was performed using a repeated-measures analysis of variance test, followed by a Tukey post hoc test for pair-wise comparisons.

Results: ICTs increased total shoulder rotation, superior translation, posterior translation, and peak subacromial contact pressure. SCR plus LDT significantly decreased internal rotation only at 60° of abduction. The effect of SCR plus LDT was most evident at lower levels of abduction. At the mid range of abduction (30°), the static stabilizing effect diminished but the dynamic stabilizing effect remained, allowing SCR plus LDT to reduce superior translation more effectively than SCR with dermal allograft alone.

Conclusions: Adding SCR to LDT adds static stabilization to a dynamic stabilizer. Therefore, SCR plus LDT may provide additional stability at the low to mid ranges of abduction.

Keywords: Superior capsule reconstruction; cadaveric study; latissimus dorsi; subacromial contact pressure; superior translation; tendon transfer.

MeSH terms

Aged
Allografts
Biomechanical Phenomena
Cadaver
Female
Humans
Male
Middle Aged
Plastic Surgery Procedures / methods*
Range of Motion, Articular / physiology*
Rotator Cuff Injuries / physiopathology
Rotator Cuff Injuries / surgery*
Shoulder Injuries
Shoulder Joint / surgery*
Superficial Back Muscles / surgery
Tendon Transfer / methods*
Tendons / transplantation*