Improved external rotation with concomitant reverse total shoulder arthroplasty and latissimus dorsi tendon transfer: A systematic review

Background: In conjunction with reverse total shoulder arthroplasty (RSA), latissimus dorsi and teres major (LD-TM) transfer has been advocated in the setting of combined loss of elevation and external rotation. The purpose of this systematic review is to summarize the clinical outcomes following RSA with LD-TM transfer. Methods: A search of PubMed, EMBASE, CINAHL, Medline, and Cochrane databases was performed between January 1, 1990 and March 1, 2016 and included articles related to outcomes following RSA with LD-TM transfer. Primary outcomes of interest were constant score, shoulder range of motion, and patient satisfaction. Secondary outcomes of interest included subjective shoulder value, simple shoulder test, activities of daily living requiring external rotation, and visual analog pain score. Additional outcomes evaluated included complications and reoperations. Frequency-weighted values of outcome data were utilized. Results: Five level IV studies involving 98 shoulders met the inclusion criteria. The mean age of the cohort was 69.1 +/- 5.19 years (range 47-85). RSA with LD-TM transfer was performed for rotator cuff arthropathy (94%) or proximal humerus fracture (6%). The average follow-up was 44.5 +/- 10.38 months (range 12-105 months). The constant score improved from 28 to 65 (p < 0.0005). Active external rotation improved from -7.4 degrees to 22.9 degrees (p < 0.0005). There was a 22.4% overall complication rate, including dislocation (5.1%), infection (5.1%), and transient nerve palsy (3.4%). Conclusion: Patients undergoing RSA with LD-TM transfer in the setting of loss of external rotation demonstrate reliable clinical improvements in shoulder function with complication rates which are comparable to RSA alone.