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- Title
Outcome Comparison of Latissimus Dorsi Transfer and Pectoralis Major Transfer for Irreparable Subscapularis Tendon Tear: A Systematic Review.
- Authors
Luo, Zhiwen; Lin, Jinrong; Sun, Yaying; Zhu, Kesen; Wang, Chenghui; Chen, Jiwu
- Abstract
Background: Latissimus dorsi transfer (LDT) and pectoralis major transfer (PMT) were developed to treat an irreparable subscapularis tendon tear (ISScT); however, the difference in their outcomes remains unclear. Purpose: To systematically review and compare the outcomes of LDT and PMT for ISScT. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed through a comprehensive search of Embase, PubMed, and the Cochrane Library. Studies of LDT or PMT were included according to the inclusion and exclusion criteria. The primary outcome was the Constant-Murley score (CMS) at the final follow-up. Secondary outcomes included the subjective shoulder value (SSV), visual analog scale (VAS) score for pain, active shoulder range of motion, and the belly-press and lift-off tests. Postoperative failure and complication rates were the safety outcome measures. Outcomes were summarized into the LDT and PMT groups, and results were compared statistically (P <.05). Results: Twelve studies were included in this review: 184 shoulders from 9 studies for the PMT group and 85 shoulders from 3 studies for the LDT group. For the PMT and LDT groups, the mean ages were 58.9 and 55.1 years, respectively, and the mean follow-up was 66.9 and 17.4 months, respectively. Overall, the LDT and PMT groups improved in the primary outcome (CMS) and secondary outcomes (SSV, VAS, ROM, and belly-press and lift-off tests), with low rates of failure and complication. When compared with the PMT group, the LDT group showed more significant improvements in CMS (35.2 vs 24.7; P <.001), active forward flexion (44.3° vs 14.7°; P <.001), abduction (35.0° vs 17.6°; P <.002), and positive belly-press test rate (45% vs 27%; P <.001). No statistically significant difference was seen between the groups in postoperative failure rate, complication rate, mean improvement of active internal rotation, VAS, or SSV. Conclusion: In general, LDT showed significantly better clinical outcomes postoperatively than did PMT. The available fair-quality evidence suggested that LDT might be a better choice for ISScT. Further evaluations on the relative benefits of the 2 surgical approaches are required, with more high-quality randomized controlled studies.
- Subjects
TENDON injuries; ROTATOR cuff injuries; ONLINE information services; MEDICAL databases; PATIENT aftercare; COMPUTER software; MEDICAL information storage &; retrieval systems; RANGE of motion of joints; SYSTEMATIC reviews; ORTHOPEDIC surgery; HEALTH outcome assessment; CONTINUING education units; VISUAL analog scale; LATISSIMUS dorsi (Muscles); PECTORALIS muscle; TREATMENT failure; ABDUCTION (Kinesiology); MEDLINE; WEIGHT lifting
- Publication
American Journal of Sports Medicine, 2022, Vol 50, Issue 7, p2032
- ISSN
0363-5465
- Publication type
Article
- DOI
10.1177/03635465211018216