Arthroscopic Lat Dorsi Transfer 2017

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Arthroscopically assisted latissimus dorsi transfer is a viable option for treatment of patients in their 50s to 70s, without arthritis of the glenohumeral joint, who suffer from massive postero-superior rotator cuff tears that are not amendable to primary repair or that have failed previous repair attempts.

Gesundheit & Medizin

@thearmclinic
Arthroscopic LDT
Lennard Funk

@thearmclinic
Acknowledgements
• LaFosse, 2002 • Grimberg, 2011
• Gerber• Gervasi

@thearmclinic
Indication for tendon transfer
• MRCT with Weakness

• Functional strength loss +/- pain

@thearmclinic
Pre-requisites of Transfer
1. Intact deltoid

2. Intact Subscapularis - maintain force-couple

3. No Pseudoparalysis

4. Good bone - fixation

5. Compliant patient (young active)

6. Teres Minor Intact

@thearmclinic
Pre-Habilitation
• shoulder therapist

• Optimise Deltoid & function

• Activity modifications

• Re-assess before surgery

@thearmclinic
Principles of the technique
• Open:
– Harvest Tendon

– Mobilise tendon

• Arthroscopy:
– Prepare surfaces

– Develop track

– Transfer tendon

– Fixation

@thearmclinic
Portals
viewing
Anchor 
insertion
Working
Suture 
Retrieval

@thearmclinic
Post-Surgery
• ER Brace - comfort only

• Pain Management

• Limit NSAIDs

• Cold Compression

• Wound Care

• Early Rehab

@thearmclinic
4 Stage Rehab
• Stage 1:

• Pain & Wound management

• Closed Chain Active-Assisted

• Stage 2:
• Wean off sling

• Progress to Open Chain exercises

• Stage 3:
• Open Active - ‘hand over elbow’ training

• Eccentric control

• Stage 4:
• Functional & Sports-specific training

• Endurance
Not Time-Based !!!

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Arthroscopic Lat Dorsi Transfer 2017

1. @thearmclinic Arthroscopic LDT Lennard Funk

2. @thearmclinic Acknowledgements • LaFosse, 2002 • Grimberg, 2011 • Gerber• Gervasi

3. @thearmclinic Cumbrian farmer

4. @thearmclinic Indication for tendon transfer • MRCT with Weakness • Functional strength loss +/- pain

5. @thearmclinic Pre-requisites of Transfer 1. Intact deltoid 2. Intact Subscapularis - maintain force-couple 3. No Pseudoparalysis 4. Good bone - fixation 5. Compliant patient (young active) 6. Teres Minor Intact

6. @thearmclinic Pre-Habilitation • shoulder therapist • Optimise Deltoid & function • Activity modifications • Re-assess before surgery

7. @thearmclinic Principles of the technique • Open: – Harvest Tendon – Mobilise tendon • Arthroscopy: – Prepare surfaces – Develop track – Transfer tendon – Fixation

8. @thearmclinic Position

14. @thearmclinic Portals viewing Anchor  insertion Working Suture  Retrieval

15. @thearmclinic

16. @thearmclinic Posterior Release

17. @thearmclinic Posterior Release

18. @thearmclinic Humerus Prep

19. @thearmclinic Suture retrieval

20. @thearmclinic Tendon Retrieval

21. @thearmclinic Tendon Retrieval

22. @thearmclinic Tendon Fixation

23. @thearmclinic Final Fixation

24. @thearmclinic Post-Surgery • ER Brace - comfort only • Pain Management • Limit NSAIDs • Cold Compression • Wound Care • Early Rehab

25. @thearmclinic 4 Stage Rehab • Stage 1: • Pain & Wound management • Closed Chain Active-Assisted • Stage 2: • Wean off sling • Progress to Open Chain exercises • Stage 3: • Open Active - ‘hand over elbow’ training • Eccentric control • Stage 4: • Functional & Sports-specific training • Endurance Not Time-Based !!!

26. @thearmclinic 6 Months Post-op

Arthroscopic Lat Dorsi Transfer 2017

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Arthroscopic Lat Dorsi Transfer 2017