Patch-Augmented Latissimus Dorsi Transfer and Open Reduction-Internal Fixation of Unstable Os Acromiale for Irreparable Massive Posterosuperior Rotator Cuff Tear

Authors:

Maximilian Petri, Joshua A Greenspoon, Sanjeev Bhatia, Peter J Millett

Abstract:

Massive rotator cuff tears usually occur as ante- rosuperior tears (involving the subscapularis and supraspinatus tendons) or, more commonly, posterosuperior tears (involving the infraspinatus and supraspinatus tendons and sometimes the teres minor tendon). In the absence of glenohumeral osteoarthritis, latissimus dorsi transfer is a treatment option for massive posterosuperior rotator cuff tears that can substantially improve chronically painful, dysfunctional shoulders. As a modification, arthroscopically assisted latissimus dorsi transfer can avoid a deltoid-splitting incision, thereby preserving the deltoid muscle, which may lead to a better clinical outcome.

This report and Video 1 describe the treatment of an active 43-year-old man with severe pain and weakness in the right shoulder after 3 failed rotator cuff repairs elsewhere (2 arthroscopic and, most recently, 1 open). He presented with pain and weakness that resulted in a significant functional deficit. On physical examination, he had a positive external rotation lag sign and a positive drop-arm sign.

Preoperative imaging showed a massive poster- osuperior rotator cuff tear retracted to the glenoid (Fig 1) with no obvious lesion of the subscapularis, as well as a hypermobile os acromiale and tenodesis of the long head of the biceps tendon. Given the patient’s young age and good medical condition, as well as the absence of joint space narrowing, he was considered too young for reverse total shoulder replacement. The treatment options included partial rotator cuff repair,4 bridging rotator cuff reconstruction with a graft, superior capsular reconstruction, or latissimus dorsi tendon transfer. Furthermore, open reductioneinternal fixation of the os acromiale was planned because it was considered to be unstable and likely causing dynamic impingement and recurrent rotator cuff tears. Therefore an arthroscopically assisted latissimus approach was not suitable in this case, and an open approach was used; the key surgical risks and technical pearls summarized in Table 1.

For the complete study: Patch-Augmented Latissimus Dorsi Transfer and Open ReductioneInternal Fixation of Unstable Os Acromiale for Irreparable Massive Posterosuperior Rotator Cuff Tear

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Patch-Augmented Latissimus Dorsi Transfer and Open Reduction-Internal Fixation of Unstable Os Acromiale for Irreparable Massive Posterosuperior Rotator Cuff Tear

Authors:

Abstract:

About the Author: Peter Millett, MD