Latissimus dorsi transfer for massive irreparable rotator cuff tears

Summary The main aim of this thesis was to gain more insight in shoulder kinematics and muscle activation patterns after a latissimus dorsi transfer (LDT) in patients with a massive irreparable posterosuperior rotator cuff tear (MIRT). Part 1 includes treatment options for the repairable and irreparable rotator cuff tear and part 2 is specifically on the LDT for an MIRT. Chapter 1 presents the general introduction on the rotator cuff tear and its reparability. If considered repairable, primary repair can be achieved by different surgical techniques. Moreover, several concomitant procedures may be performed as adjunct to the rotator cuff repair. These techniques and concomitant procedures are described in the review article presented in chapter 2. A systematic review and meta-analysis reporting clinical outcome after primary cuff repair techniques, concomitant surgical procedures and aftercare is presented in chapter 3. Treatment options for irreparable posterosuperior rotator cuff tears are reported and compared in a systematic review and meta-analysis in chapter 4. The LDT is a well-known and viable treatment option for an MIRT. However, the mode of function is yet to be understood. 3-Dimensional shoulder kinematics and muscle activation patterns after an LDT for an MIRT are presented in chapter 5 and compared to the asymptomatic contralateral shoulder (ACS). The change in shoulder kinematics after an LDT is achieved by reprogramming activation in the muscles that are responsible for active shoulder elevation. Shoulder muscle activation patterns in active shoulder elevation were reported after an LDT and compared to the ACS in chapter 6. Although long-term good results after an LDT are reported, failure is not uncommon. To determine the type of failure after LDT, the intra and interobserver agreement after LDT with MRI was assessed in chapter 7. The thesis concludes with a general discussion in chapter 8.