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36-year-old laborer with massive rotator cuff tear and associated supraspinatus atrophy
84%
2328/2788
67-year-old non-laborer with rotator cuff tear arthropathy and pseudoparalysis
8%
236/2788
34-year-old laborer with massive rotator cuff tear and thoracodorsal nerve palsy
5%
128/2788
63-year-old with supraspinatus rotator cuff tear and subacromial impingement
2%
45/2788
37-year-old non-laborer with extensive chondrolysis following a rotator cuff repair and indwelling pain catheter placement for postoperative pain
1%
30/2788
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The most appropriate candidate for a latissimus transfer is the young laborer with a massive rotator cuff tear and atrophy of the supraspinatus fossa. In 1988, Gerber et al described the technique of latissimus dorsi tendon transfer as a reconstructive option for irreparable posterosuperior rotator cuff defects. This procedure is predicated on restoring an active external rotation and flexion moment at the glenohumeral joint, as these motions constitute the primary functional deficits for this configuration of massive cuff tear. Miniaci and Mcleod present Level 4 evidence of 17 patients who underwent latissimus dorsi tendon transfer after failed repair of a massive tear of the rotator cuff and found significant relief of pain (p<0.0001) and a significant improvement in function (p<0.001 for all activities except lifting more than fifteen pounds). Warner and Parsons present Level 3 evidence of 16 patients who underwent latissimus dorsi transfer as a salvage procedure compared to 6 patients who had transfer as a primary procedure. They concluded that salvage reconstruction of failed prior rotator cuff repairs yields more limited gains in satisfaction and function than primary latissimus dorsi transfer.
4.2
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