Our Summary

This research paper discusses the challenges of treating large, unrepairable rotator cuff tears in young, active patients who don’t have arthritis. One treatment option is a surgical technique called latissimus dorsi tendon transfer (LDTT), which was first introduced in 1988. This procedure has shown positive results in both the short and long term in many studies. However, these studies mostly involved patients who had not undergone previous surgery.

The paper suggests that using LDTT as a “last resort” treatment after other surgeries have failed is not as reliable in terms of reducing pain and improving function, particularly in patients with severe fatty build-up in the posterior cuff muscles and a certain distance between bones in the shoulder. Despite this, the paper suggests that LDTT should not be completely ruled out as a primary treatment for young, active patients with large, unrepairable rotator cuff tears and a specific muscle condition, as this procedure has shown good to excellent results in these cases.

However, the author advises caution in using LDTT as a “last resort” treatment in cases where other surgeries have failed, where the patient has limited range of motion, a certain distance between bones in the shoulder, and severe fatty build-up in the posterior cuff muscles, due to the high failure rate and unreliable results. The author does not currently use LDTT as a “last resort” treatment in his own practice.

FAQs

  1. What is the latissimus dorsi tendon transfer (LDTT) procedure?
  2. Is the LDTT procedure a reliable “last resort” treatment for rotator cuff tears?
  3. Why does the author advise caution in using LDTT as a “last resort” treatment?

Doctor’s Tip

A helpful tip a doctor might give to a patient undergoing rotator cuff repair is to follow the post-operative rehabilitation program carefully. This program typically includes physical therapy to help regain strength, flexibility, and range of motion in the shoulder. It is important to adhere to the exercises and recommendations provided by your healthcare team to ensure a successful recovery and optimal outcomes. Additionally, it is important to avoid activities that may put stress on the repaired rotator cuff, such as heavy lifting or overhead movements, until cleared by your doctor. Consistent follow-up appointments with your healthcare provider are also crucial to monitor progress and address any concerns or complications that may arise.

Suitable For

Typically, patients who are recommended for rotator cuff repair surgery are those who have a large, unrepairable rotator cuff tear, are young and active, and do not have arthritis. These patients may have tried conservative treatments such as physical therapy and medication without success, and may be experiencing significant pain and loss of function in their shoulder. In some cases, patients may also have specific muscle conditions or other anatomical factors that make them good candidates for rotator cuff repair surgery. It is important for patients to discuss their individual case with their healthcare provider to determine the best treatment option for their specific situation.

Timeline

Before rotator cuff repair:

  1. Patient experiences shoulder pain, weakness, and limited range of motion.
  2. Patient undergoes imaging tests such as MRI to diagnose a rotator cuff tear.
  3. Patient is recommended physical therapy and other non-surgical treatments to manage symptoms.
  4. If symptoms persist or worsen, patient may be recommended for rotator cuff repair surgery.

After rotator cuff repair:

  1. Patient undergoes rotator cuff repair surgery, which may be arthroscopic or open.
  2. Patient goes through a period of immobilization and physical therapy to aid in recovery.
  3. Patient gradually regains strength and range of motion in the shoulder.
  4. Patient may experience some pain and stiffness during the recovery process.
  5. Over time, patient’s shoulder function improves, and they are able to return to normal activities.
  6. Long-term follow-up is needed to monitor the success of the surgery and address any potential complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about rotator cuff repair include:

  1. What are the different treatment options available for my rotator cuff tear, and why is latissimus dorsi tendon transfer (LDTT) being considered for me?
  2. What are the potential risks and complications associated with LDTT surgery?
  3. What is the success rate of LDTT surgery in patients with similar characteristics to mine?
  4. What is the expected recovery time and rehabilitation process after LDTT surgery?
  5. Are there any alternative treatments or therapies that I should consider before opting for LDTT surgery?
  6. How will LDTT surgery affect my range of motion and overall shoulder function in the long term?
  7. Are there any specific factors, such as severe fatty build-up in the posterior cuff muscles or a certain distance between bones in the shoulder, that may impact the success of LDTT surgery in my case?
  8. Have you performed LDTT surgery on other patients with similar characteristics to mine, and what were the outcomes?
  9. What is your experience and expertise in performing LDTT surgeries, and how many of these procedures have you done successfully?
  10. Are there any lifestyle changes or modifications that I should consider after LDTT surgery to optimize my recovery and long-term shoulder health?

Reference

Authors: Li X. Journal: Arthroscopy. 2020 Jan;36(1):95-98. doi: 10.1016/j.arthro.2019.10.017. PMID: 31864607