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Regarding “High Clinical Failure Rate After Latissimus Dorsi Transfer for Revision Massive Rotator Cuff Tears”

      The article in the January 2020 issue entitled “High Clinical Failure Rate After Latissimus Dorsi Transfer for Revision Massive Rotator Cuff Tears,” by Muench et al.,
      • Muench L.N.
      • Kia C.
      • Williams A.A.
      • Avery III, D.M.
      • Cote M.P.
      • Reed N.
      • Arciero R.A.
      • Chandawarkar R.
      • Mazzocca A.D.
      High clinical failure rate after latissimus dorsi transfer for revision massive rotator cuff tears.
      caught my interest, and after reading the article and the commentary by Li,
      • Li X.
      Editorial commentary: Is it time to abandon the latissimus dorsi tendon transfer as a salvage procedure for patients with large irreparable rotator cuff tears that failed primary repair?.
      I felt it necessary to comment.
      The notion that the literature does not support the use of this procedure for revision of failed rotator cuff repairs does not reflect our report of 18 patients (mean age 60 years) with between 1 and 4 failed prior cuff repair procedures.
      • Birmingham P.M.
      • Neviaser R.J.
      Outcome of latissimus dorsi transfer as a salvage procedure for failed rotator cuff repair with loss of elevation.
      In that report, zero cases failed owing to rupture of the transfer. Of the remaining 17 patients, none could elevate the arm to 90° preoperatively, but all could elevate to ≥90° postoperatively. All had similar statistically significant improvements in other motions as well as in pain. Importantly, all patients stated that they would undergo the operation again. American Shoulder and Elbow Surgeons (ASES) scores improved from a mean of 43 to a mean of 61. Thus, in contradistinction to the authors’ results and the commentator’s assertions, we do not agree that this operation should not be used in the presence of prior failed rotator cuff surgery.
      Additionally, the authors’ criterion of a minimal increase of 17 points in the ASES score as the dividing line between clinical success and failure, using the paper by Tashjian et al.
      • Tashjian R.Z.
      • Deloach J.
      • Green A.
      • Porucznik C.A.
      • Powell A.P.
      Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease.
      as the reference, does not correlate with the statement in that paper that “our finding that the minimal clinically important difference in the ASES fell between 12 and 17 points was supported even when we took into account the effects of the duration of follow-up.” Using the broader range that Tashjian used would likely have increased the success rate in the paper by Muench et al.
      • Muench L.N.
      • Kia C.
      • Williams A.A.
      • Avery III, D.M.
      • Cote M.P.
      • Reed N.
      • Arciero R.A.
      • Chandawarkar R.
      • Mazzocca A.D.
      High clinical failure rate after latissimus dorsi transfer for revision massive rotator cuff tears.

      Supplementary Data

      References

        • Muench L.N.
        • Kia C.
        • Williams A.A.
        • Avery III, D.M.
        • Cote M.P.
        • Reed N.
        • Arciero R.A.
        • Chandawarkar R.
        • Mazzocca A.D.
        High clinical failure rate after latissimus dorsi transfer for revision massive rotator cuff tears.
        Arthroscopy. 2020; 36: 88-94
        • Li X.
        Editorial commentary: Is it time to abandon the latissimus dorsi tendon transfer as a salvage procedure for patients with large irreparable rotator cuff tears that failed primary repair?.
        Arthroscopy. 2020; 36: 95-98
        • Birmingham P.M.
        • Neviaser R.J.
        Outcome of latissimus dorsi transfer as a salvage procedure for failed rotator cuff repair with loss of elevation.
        J Shoulder Surg. 2008; 17: 871-874
        • Tashjian R.Z.
        • Deloach J.
        • Green A.
        • Porucznik C.A.
        • Powell A.P.
        Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease.
        J Bone Joint Surg Am. 2010; 92: 296-303

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