Deltoid muscular flap transfer for the treatment of irreparable rotator cuff tears

The purpose of this study was to evaluate the outcome of deltoid muscle flap transfer for the treatment of irreparable rotator cuff tears. In a retrospective study 20 consecutive patients were evaluated. The index procedure took place between 2000 and 2003. Fifteen patients were male, mean age was 62 years. Inclusion criterion was a rotator cuff defect Bateman grade IV. Exclusion criteria were smaller defects, shoulder instability and fractures of the injured shoulder. An open reconstruction with acromioplasty and a pedicled delta flap was performed. Follow up period was mean 42 months. Follow-up included clinical examination, Magnetic Resonance Imaging (MRI) and the Constant and Simple (CS) shoulder tests. According to the Constant shoulder test the results were good in 13 patients, fair in 5 and unsatisfactory in 2. The pre-operative Constant Score improved from mean 25.7 points (±5.3) to 72.3 (±7.8) at follow-up. The mean values for the subcategories of CS increased significantly from 3.9 to 14.4 points for pain and from 4.2 to 15.9 points for activities daily routine (p<0.05). The change in range of motion and strength were not significant (p>0.05). Results of the Simple Shoulder Test showed a significant increase of the mean values from pre-operative 4.3 to 14.7 points post-operatively. MRI showed a subacromial covering of the defect in all cases, all flaps where intact on MRI but always the flap showed marked fatty degeneration. In conclusion, the delta flap is a simple method for the repair of large defects of the rotator cuff leading to satisfying medium results.

[1]  P. Habermeyer,et al.  Pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears , 2010, International Orthopaedics.

[2]  F. Panza,et al.  Short-term Effects of High-Intensity Laser Therapy Versus Ultrasound Therapy in the Treatment of People With Subacromial Impingement Syndrome: A Randomized Clinical Trial , 2009, Physical Therapy.

[3]  B. Augereau,et al.  Long-term Clinical and MRI Results of Open Repair of the Supraspinatus Tendon , 2009, Clinical orthopaedics and related research.

[4]  M. Mayerhoefer,et al.  Shoulder Impingement: Relationship of Clinical Symptoms and Imaging Criteria , 2009, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[5]  S. Nho,et al.  Rotator cuff tears: pathology and repair , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

[6]  L. Nouisri,et al.  [Results of the deltoid flap for surgery of rotator cuff tears]. , 2008, La Tunisie medicale.

[7]  Olivier Verborgt,et al.  Long-term outcomes after deltoid muscular flap transfer for irreparable rotator cuff tears. , 2008, Journal of shoulder and elbow surgery.

[8]  R. Buchbinder,et al.  Surgery for rotator cuff disease. , 2008, The Cochrane database of systematic reviews.

[9]  C. Gerber,et al.  Teres minor integrity predicts outcome of latissimus dorsi tendon transfer for irreparable rotator cuff tears. , 2007, Journal of shoulder and elbow surgery.

[10]  C. Gerber,et al.  The biomechanical role of the subscapularis in latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. , 2006, Journal of shoulder and elbow surgery.

[11]  Gerald R. Williams,et al.  Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Factors affecting outcome. , 2006, The Journal of bone and joint surgery. American volume.

[12]  D. Liem,et al.  Transfer of the tendon of latissimus dorsi for the treatment of massive tears of the rotator cuff: a new single-incision technique. , 2006, The Journal of bone and joint surgery. British volume.

[13]  E. Audenaert,et al.  Reconstruction of massive rotator cuff lesions with a synthetic interposition graft: a prospective study of 41 patients , 2006, Knee Surgery, Sports Traumatology, Arthroscopy.

[14]  B. Augereau,et al.  Massive tears of the rotator cuff treated with a deltoid flap , 2004, International Orthopaedics.

[15]  F C T van der Helm,et al.  Biomechanical analysis of tendon transfers for massive rotator cuff tears. , 2004, Clinical biomechanics.

[16]  R. Abdalla,et al.  Interventions for tears of the rotator cuff in adults. , 2004, The Cochrane database of systematic reviews.

[17]  J. Auerbach,et al.  Latissimus dorsi tendon transfer for massive rotator cuff tears: a cadaveric study. , 2003, Journal of shoulder and elbow surgery.

[18]  F. Langlais,et al.  [Deltoid muscle flap for massive rotator cuff tears: 41 cases with a mean 7-year (minimum 5 year) follow-up]. , 2002, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur.

[19]  F. Landsiedl,et al.  Results of open repair of the rotator cuff – a long-term review of 79 shoulders , 2001, Archives of Orthopaedic and Trauma Surgery.

[20]  R H Cofield,et al.  Surgical Repair of Chronic Rotator Cuff Tears: A Prospective Long-Term Study , 2001, The Journal of bone and joint surgery. American volume.

[21]  A. Miniaci,et al.  Transfer of the latissimus dorsi muscle after failed repair of a massive tear of the rotator cuff. A two to five-year review. , 1999, The Journal of bone and joint surgery. American volume.

[22]  Freddie H. Fu,et al.  Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction , 1998, Knee Surgery, Sports Traumatology, Arthroscopy.

[23]  M Matsuo,et al.  [Oxidative stress and aging]. , 1997, Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics.

[24]  M. Aoki,et al.  Transfer of latissimus dorsi for irreparable rotator-cuff tears. , 1996, The Journal of bone and joint surgery. British volume.

[25]  J. Le Huec,et al.  [Results of a series of deltoid flaps for the treatment of massive rotator cuff tears with an average follow-up of 3.5 years]. , 1996, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur.

[26]  M. Friedman,et al.  Critical Analysis of Knee Ligament Rating Systems , 1995, The American journal of sports medicine.

[27]  D Goutallier,et al.  Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. , 1994, Clinical orthopaedics and related research.

[28]  P. Gleyze,et al.  Functional and anatomical results after rotator cuff repair. , 1994, Clinical orthopaedics and related research.

[29]  C. A. Rockwood,et al.  Shoulder impingement syndrome: diagnosis, radiographic evaluation, and treatment with a modified Neer acromioplasty. , 1993, The Journal of bone and joint surgery. American volume.

[30]  C Gerber,et al.  Latissimus dorsi transfer for the treatment of irreparable tears of the rotator cuff. , 1992, Clinical orthopaedics and related research.

[31]  C Gerber,et al.  Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. , 1991, The Journal of bone and joint surgery. British volume.

[32]  M. Watson.  Major ruptures of the rotator cuff. The results of surgical repair in 89 patients. , 1985, The Journal of bone and joint surgery. British volume.

[33]  R. Samilson,et al.  Dislocation arthropathy of the shoulder. , 1983, The Journal of bone and joint surgery. American volume.

[34]  C. Neer,et al.  Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. , 1972, The Journal of bone and joint surgery. American volume.

[35]  J. E. Bateman.  THE DIAGNOSIS AND TREATMENT OF RUPTURES OF THE ROTATOR CUFF. , 1963, The Surgical clinics of North America.