Management of Massive Irreparable Rotator Cuff Tears: The Role of Tendon Transfer*† by Jon J. P. Warner J Bone Joint Surg Am Volume 82(6):878-878 June.

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Presentation transcript:

Management of Massive Irreparable Rotator Cuff Tears: The Role of Tendon Transfer*† by Jon J. P. Warner J Bone Joint Surg Am Volume 82(6): June 1, 2000 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Oblique sagittal plane magnetic resonance image of a left shoulder with a chronic massive tear involving the supraspinatus (Ss) and the infraspinatus (Is). Jon J. P. Warner J Bone Joint Surg Am 2000;82:878 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 2-A through 2-D: Drawings showing the operative technique for the pectoralis major tendon transfer.Fig. 2-A: The superior and inferior borders of the pectoralis major are exposed. Jon J. P. Warner J Bone Joint Surg Am 2000;82:878 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-B: The sternal portion is dissected, with preservation of the clavicular portion. Jon J. P. Warner J Bone Joint Surg Am 2000;82:878 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-C: The sternal portion is transferred underneath the clavicular portion and is repaired into the lesser tuberosity. Jon J. P. Warner J Bone Joint Surg Am 2000;82:878 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-D: The sternal head of the pectoralis passes underneath the clavicular head, which acts as a pulley, keeping the line of pull of the sternal head closer to the line of the subscapularis tendon. Jon J. P. Warner J Bone Joint Surg Am 2000;82:878 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Photograph showing the interval between the sternal head (SH) and the clavicular head (CH) of the pectoralis major. Jon J. P. Warner J Bone Joint Surg Am 2000;82:878 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 4-A through 4-D: Drawings showing the operative technique for the latissimus dorsi tendon transfer.Fig. 4-A: The patient is placed in the lateral decubitus position, and an accessory posterior incision is made in order to identify and harvest the lati... Jon J. P. Warner J Bone Joint Surg Am 2000;82:878 ©2000 by The Journal of Bone and Joint Surgery, Inc.

The tendon is detached from the humerus and then dissected retrograde to the neurovascular pedicle. Jon J. P. Warner J Bone Joint Surg Am 2000;82:878 ©2000 by The Journal of Bone and Joint Surgery, Inc.

The tendon is transferred underneath the deltoid and the acromion. Jon J. P. Warner J Bone Joint Surg Am 2000;82:878 ©2000 by The Journal of Bone and Joint Surgery, Inc.

With the shoulder abducted and in external rotation, the tendon is secured to the remnant of the rotator cuff tendons medially, to the greater tuberosity laterally, and to the subscapularis anteriorly. Jon J. P. Warner J Bone Joint Surg Am 2000;82:878 ©2000 by The Journal of Bone and Joint Surgery, Inc.

The latissimus dorsi tendon is often small and thin. Jon J. P. Warner J Bone Joint Surg Am 2000;82:878 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Photograph showing the latissimus dorsi tendon after the fascia lata autograft has been sewn over it to reinforce it prior to transfer. Jon J. P. Warner J Bone Joint Surg Am 2000;82:878 ©2000 by The Journal of Bone and Joint Surgery, Inc.