Osteolysis at the insertion of L'Episcopo tendon transfer: Incidence and clinical impact

Introduction: During a L'Episcopo transfer procedure, the tendons of the latissimus dorsi and teres major are reinserted on the posterolateral side of the humeral shaft to restore active external rotation. The aim of this study was to monitor the radiological changes at the insertion point of this transfer and to evaluate its impact on the clinical outcomes. Materials and methods: In this retrospective, single-center study, 13 patients (mean age 56 years; 19-84) were reviewed after a minimum follow-up of 2 years. The L'Episcopo transfer was done either alone (n = 2) or in combination with reverse shoulder arthroplasty (n = 11). The same transfer technique was used in both instances, with reattachment by transosseous sutures. The clinical assessment consisted of the Constant score (CS), the Activities of Daily Living Requiring Active External Rotation (ADLER) score and the Subjective Shoulder Value (SSV). Radiographs were used to look for signs of osteolysis of the cortical bone in the tendon transfer areas and classified as grade 1 (minor erosion), grade 2 (moderate erosion) and grade 3 (major erosion). Results: At a mean follow-up of 37 months (24-72), the mean CS was 60 points (32-75), the ADLER was 21 points (15-30) and the SSV was 77% (10-95). In the radiographic analysis, 10/13 patients had osteolysis visible in the transfer area: 2 were grade 1 (15%), 1 was grade 2 (8%), 7 were grade 3 (54%). There was no statistical correlation between the presence of osteolysis and the clinical outcomes. Nevertheless, external rotation with elbow at side and forward flexion were better in the patients who had osteolysis >= grade 2. Conclusion: The L'Episcopo transfer is associated with frequent osteolysis of the humeral cortex where the transfer is attached, even though the transfer appears effective. Long-term follow-up will be needed to evaluate the impact of this osteolysis on the stability of any shoulder arthroplasty implants. Level of evidence: IV; retrospective study. (c) 2021 Elsevier Masson SAS. All rights reserved.