J Shoulder Elbow Surg (2023) 32, 1016–1021

www.elsevier.com/locate/ymse

Concomitant latissimus dorsi tendon transfer

during reverse total shoulder arthroplasty does
not improve active external rotation or clinical
outcomes in patients with external rotation
deficit
J. Michael Wiater, MDa,*, Olamide Oshikoya, MDa, Edward Shields, MDb,
Alexander D. Vara, MDc, Leonardo Cavinatto, MDa, Denise M. Koueiter, MSa

a
Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
b
Orthopaedic Associates of Muskegon, Muskegon, MI, USA
c
Palmetto General Hospital, Hialeah, FL, USA

Background: To assess the role of latissimus dorsi tendon transfer (LDT) concomitant with reverse total shoulder arthroplasty in pa-
tients with external rotation (ER) deficit secondary to severe rotator cuff deficiency with and without glenohumeral arthritis.
Methods: Patients with a positive external lag sign and <10
of active external rotation (aER) treated with reverse shoulder arthroplasty
at a single institution with a minimum 12-month follow-up were retrospectively identified from a prospective database. Basic demo-
graphic information along with preoperative and postoperative range of motion (ROM) measures, American Shoulder and Elbow Sur-
geons score (ASES), Visual Analog Scale (VAS) pain, and Subjective Shoulder Value scores were obtained. Statistical analysis was
performed to compare ROM and functional outcomes between patients who underwent concomitant LDT and those with no transfer
(NT).
Results: The LDT (n ¼ 31) and NT (n ¼ 33) groups had similar age, sex distributions, and follow-up length average (24 vs. 30 months).
No differences were found between groups at baseline, final follow-up, or magnitude of change for ASES, VAS pain, and Subjective
Shoulder Value scores. Baseline ROM measures were similar, except for the LDT group having slightly less aER (8
vs. 0
;
P ¼ .004). In addition, all postoperative ROM measures including aER were similar, except for a slight improvement in active internal
rotation in the NT group. The majority of patients were satisfied with their outcome (LDT 84% (n ¼ 26); NT 87% (n ¼ 27); P ¼ .72).
Conclusion: Patients with ER deficit secondary to severe rotator cuff deficiency with and without glenohumeral arthritis undergoing
reverse total shoulder arthroplasty do not have significantly improved ER or patient-reported outcome measures with LDT.
Level of evidence: Level III; Retrospective Cohort Comparison; Treatment Study
Ó 2022 The Author(s). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: Reverse shoulder arthroplasty; latissimus dorsi tendon transfer; external rotation lag; posterior rotator cuff; humeral rotation;
functional outcomes

This study was approved under Beaumont Health institutional review *Reprint requests: J. Michael Wiater, MD, Department of Orthopaedic
board protocol # 2006-088. Surgery, Beaumont Health System, 3535 W 13. Mile Road, Suite 744,
Royal Oak, MI 48073, USA.
E-mail address: [email protected] (J.M. Wiater).

1058-2746/Ó 2022 The Author(s). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
https://doi.org/10.1016/j.jse.2022.11.011
Concomitant latissimus dorsi tendon transfer for RTSA 1017

drift of the arm after release was considered positive, signifying

Reverse total shoulder arthroplasty (RTSA) results in posterior rotator cuff dysfunction.
consistent improvements in shoulder function and pain for Later in the study period after the senior author became aware
patients with severe rotator cuff deficiency with and of published reports of LDT showing benefit in RTSA patients
without glenohumeral arthritis.8,10,20-24 Although restora- with ER deficiency, patients were indicated for LDT after
tion of forward elevation and improved patient-reported demonstrating a positive ER lag sign and minimal aER. Thirty-
outcomes have been repeatedly demonstrated after RTSA, one consecutive patients meeting the inclusion criteria underwent
external rotation (ER) is less reliably restored.7,22,23 RTSA with concomitant LDT. All patients in the LDT group
Preoperative deficits in ER with dysfunction of the poste- received a Zimmer trabecular metal reverse humeral stem
rior rotator cuff may not be compensated for by deltoid (Zimmer, Warsaw, IN, USA) with either a Zimmer reverse gle-
function,7 and lower functional outcomes scores have been nosphere/baseplate (n ¼ 23) or a DJO Encore reverse glenosphere/
baseplate (n ¼ 10 [Enovis, Lewisville, TX, USA]). The LDT
reported after RTSA in patients with preoperative teres
group was compared to a matched cohort of RTSA patients treated
minor fatty infiltration.22,23 earlier in the study period who met inclusion criteria, but did not
The latissimus dorsi tendon transfer (LDT) was initially undergo concomitant LDT, the non-transfer (NT) group. All pa-
described for restoration of ER in the setting of massive and tients in the NT group received a Zimmer reverse humeral stem
irreparable posterosuperior rotator cuff injuries.11,27 This and glenosphere/baseplate. Patients were excluded from this study
tendon transfer, either isolated or combined with teres if they were treated for fracture, malunions, nonunions, revision
major transfer (TMT), has subsequently been modified for arthroplasty surgery, or had a prior infection.
use during RTSA in the setting of posterior rotator cuff All procedures were performed by a single surgeon through a
deficits.5,10 Results after tendon transfers for improving ER standard deltopectoral approach. The subscapularis tendon was
in the setting of RTSA are conflicting. While Gerber et al, tenotomized if present. The LDT was performed during the RTSA
Boileau et al, and others have reported significant ER by harvesting the isolated latissimus dorsi tendon through a single
deltopectoral incision. Approximately 1.5 cm of the upper pec-
improvement and functional gains in patients undergoing
toralis major tendon was released to gain access to the latissimus
RTSA concomitant with LDT or LDT and TMT,5,10,20,21 a dorsi tendon. The tendon was then detached from the humerus,
recent high-quality comparative study did not find signifi- tagged with heavy braided sutures, and shuttled to the postero-
cant differences in outcomes or ER improvement when lateral aspect of the humerus after identification and protection of
LDT and TMT were performed in addition to RSTA.26 the radial and axillary nerves. The teres major tendon was iden-
The purpose of this study was to assess the role of LDT tified deep to the latissimus dorsi tendon and left intact to preserve
concomitant with RTSA in patients with ER deficit sec- extension and internal rotation (IR) of the shoulder. Two running,
ondary to severe rotator cuff deficiency with and without locked heavy nonabsorbable sutures were placed in the latissimus
glenohumeral arthritis. We hypothesized that patients with dorsi tendon, which were secured through bone tunnels at the
a LDT would have increased active external rotation (aER) posterolateral aspect of the bicipital groove after implantation of
gains and improved functional outcome scores. the humeral stem and prior to wound closure. The subscapularis
tendon, if present, was not repaired due to concern for limitation
of ER from the subscapularis serving as a checkrein. The pec-
toralis major tendon was repaired at the end of the case. Post-
Methods operatively, the arm was protected in an abduction pillow
immobilizer for 4 weeks.
Patients

A retrospective review of a prospectively collected shoulder Clinical evaluation

arthroplasty registry was queried for patients diagnosed with se-
vere rotator cuff deficiency and clinically decreased ER. From One independent clinical research nurse examined all patients
2007 through 2014, patients undergoing RTSA by the senior both preoperatively and postoperatively. Functional outcomes
author were offered enrollment in a prospective, international were assessed using the American Shoulder and Elbow Surgeons
review board-approved database. Patients were asked to return (ASES) score, ASES Activities of Daily Living (ADL) score,17
postoperatively at 3 months, 1 year, and yearly thereafter for Visual Analog Scale (VAS) for pain (0 (none) to 10 (highest
radiographic analysis and outcomes data collection. Inclusion possible)), and Subjective Shoulder Value (SSV).12,15,17
criteria were patients indicated for reverse total shoulder arthro- A standard goniometer was used to measure active forward
plasty due severe rotator cuff deficiency with or without arthritis elevation (aFE) and aER range of motion (ROM) with the
as documented via plain radiography and/or magnetic resonance shoulder in 0 degrees of abduction. Active internal rotationaIR
imaging and who had ER deficit with a minimum 12-month ROM was assessed as the highest spinal level that the patient’s
follow-up. ER deficit was defined as a positive ER lag sign and thumb was able to reach. Additional patient demographics were
minimal (less than 10
) aER. The ER lag sign was conducted by obtained directly from the database. The primary outcome mea-
the examiner passively flexing the patient’s elbow to 90
with the sure was the change in aER. Secondary outcomes measures
arm in slight abduction and then passively rotating the arm to included ASES score, VAS pain, SSV score, and ROM measures.
maximal ER. The patient was then asked to actively hold the arm IR was coded as follows: 1 point for end of thumb to lateral thigh,
at this position. When the patient was unable to hold the maxi- 2 points to the buttock, 3 points to lumbosacral junction, 4 points
mally externally rotated position, the resulting involuntary internal at L3, 5 points to T12, and 6 points to T7.
1018 J.M. Wiater et al.

Table I Basic demographics for study groups

Latissimus transfer (n ¼ 31) No transfer (n ¼ 33) P value
Age 68  10 70  8 .34
Gender (female) 52% 70% .20
Follow-up length (mo) 30  15 24  14 .13

Statistical analysis (P ¼ .442), Pain (P ¼ .847), SSV (P ¼ .584), aFE

(P ¼ .229), aER (P ¼ .350), or aIR (P ¼ .069).
All statistical analyses were performed using SPSS (version 22; There were no differences in patient-reported outcome
IBM, Armonk, NY, USA). First, the equal variance and normality measures between the LDT and NT groups regarding pre-
assumptions of continuous data were assessed using Levene’s test operative, postoperative, and overall changes in ASES
and the Shapiro-Wilk test, respectively. Unpaired t-test and score, ASES ADL score, VAS pain score, and SSV score
Mann–Whitney U tests were used to assess differences in nor- (Table III). Complication rate was not different between
mally distributed and non-normally distributed independent groups.
outcome variables, respectively. Since all patients in the LDT
group did not have the same glenoid implant, a sub analysis was
run comparing the degree of improvement in the NT,
LDT þ Zimmer baseplate, and LDT þ DJO baseplate. For this
Discussion
sub analysis a 1-way ANOVA was used to compare change from
preoperative to postoperative for all variables. Aggregate results The principal finding of this study was that LDT during
are reported as mean [95% confidence interval] or  Standard RTSA in patients with ER deficit did not result in
Deviation. improvement in the primary outcome measure or secondary
outcome measures. aER and functional outcome scores
were not significantly different between the study group
Results and control group after one year.
Increased Disabilities of the Arm, Shoulder, and Hand
During the later study period, 31 consecutive patients who and poor VAS have been shown in patients with aER
met inclusion criteria underwent RTSA with concomitant restriction.16 Several studies have documented poor
LDT. These patients were compared to a matched cohort of improvement or even worsening of humeral rotation
patients treated earlier in the study period before the senior following RTSA.7,19,24 Poor rotation following RTSA can
author was performing LDT, who met inclusion criteria and be attributed to multiple factors, such as the deltoid fibers
received reverse total shoulder arthroplasty without an LDT assuming a more vertical line of pull, the medialized center
(no transfer [NT] group). There were 64 patients included of rotation reducing tension on remaining rotator cuff
in the analysis, 31 with a LDT, and 33 with NT. Average muscles, and the potential of mechanical impingement.1,14
age (LDT 68  10; NT 70  8; P ¼ .34), sex distributions, LDT is a technique first described in 1947 for the treat-
and length of follow-up (LDT 30  15 vs. NT ment of neonatal brachial plexus palsy26 and involves
24  14 months; P ¼ .134) were similar between groups transferring the native insertion of the tendon from the
(Table I). medial intertubercular groove, where it acts as an internal
Preoperative aFE and aIR were similar for both groups, rotator and adductor, to the greater tuberosity posteriorly
with aER being slightly lower in the LDT group (LDT 8 around the humerus, where it then can act as an external
12
vs. NT 0  9
; P ¼ .004). At final follow-up, all ROM rotator. Multiple studies have documented its efficacy in
measures except for aIR were similar for both groups, restoring aER in irreparable rotator cuff tears.2,4,13
including the primary outcome measure (aER). Change in Gerber et al10 first introduced LDT in conjunction with
aIR was significantly worse in the LDT group (LDT aIR RTSA in 2007 with a 2-incision technique, utilizing a
change 0.29 levels vs. NT 0.77 levels; P ¼ .01; Table II). deltopectoral approach with a second incision lateral to the
The majority of patients were satisfied with their outcome posterior axilla. The latissimus dorsi tendon is passed from
(LDT 84% [n ¼ 26]; and NT 87% [(n ¼ 27]; P ¼ .72). the inferior incision into the deltopectoral incision, and the
Since 10 of the patients in the LDT group also had a tendon is secured transosseously to the posterolateral aspect
slightly more lateralizing glenoid implant (DJO Encore of the greater tuberosity.10 The strands of tagged suture are
glenosphere/baseplate), a sub analysis was run comparing passed through bone tunnels into the medullary canal and
the degree of improvement in the NT, LDT þ Zimmer tied over a 7-hole button plate inside the medullary canal.10
glenosphere/baseplate, and LDT þ DJO glenosphere/ In this series of 12 patients, there was significant
baseplate, to assess if the baseplate impacted the overall improvement in forward flexion, abduction, strength, SSV,
results. The degree of change did not vary amongst sub- relative Constant score, score for ADL, and pain.10 aER
groups for the ASES score (P ¼ .629), ASES ADL increased on average by only 7
and was not significantly
Concomitant latissimus dorsi tendon transfer for RTSA 1019

Table II Range of motion measure comparisons

Latissimus transfer (n ¼ 31) No transfer (n ¼ 33) P value
Preoperative
aFE 72  36
74  33
.83
aIR 3.5  1.3 2.8  1.4 .23
aER 8  12
0  9
.004*
Postoperative
aFE 123  24
115  30
.26
aIR 3.2  1.6 3.7  1.4 .31
aER 14  13
17  15
.43
Change from baseline
aFE 50  40
37  49
.25
aIR 0.29  1.7 0.77  1.9 .014*
aER 22  15
17  15
.15
aFE, active forward elevation; aIR, active internal rotation; aER, active external rotation.
All measures in degrees, except active internal rotation coded based on level reached by upper thumb, see Methods.
* Denotes P < .05.

Table III Functional outcome measures

Latissimus transfer (n ¼ 31) No transfer (n ¼ 33) P value
Preoperative
ASES 25.6  15 25.3  15 .95
ASES ADL 7.5  4 8.3  4 .41
VAS pain 7.4  2 7.7  2 .38
SSV score 19  19 16  16 .56
Postoperative
ASES 69.5  22 71.3  28 .34
ASES ADL 17.6  7 18.8  10 .29
VAS pain 2.0  3 2.0  3 .65
SSV score 71  23 71  29 .50
Change from baseline
ASES 44  23 46  31 .76
ASES ADL 10  7 10  11 .89
VAS pain 5.4  3 5.7  3 .71
SSV score 53  26 55  31 .81
ASES, American Shoulder and Elbow Surgeons score; ADL, activities of daily living; VAS, Visual Analog Scale; SSV, Subjective Shoulder Value.

different from baseline.10 Subsequently, Boileau et al5 from 6
to 38
, and improved pain and functional outcome
modified the L’Episcopo procedure by transferring both scores.21 Although these reports show improvement of ER
latissimus dorsi and teres major through a single delto- following LDT, they are case series with no control group
pectoral approach. The 2 tendons were rerouted and reat- for comparison.
tached laterally on the humerus.5 There were 11 patients in Recently, Young et al conducted a randomized trial of 28
their series and they reported an average 28
increase of patients with rotator cuff tear arthropathy and loss of
aER.5 Puskas et al reported longer-term follow-up in a elevation and ER who underwent RTSA with or without
larger series of 41 shoulders at 53 months average follow- LDT þ TMT.26 With a follow-up of 2 years, the authors did
up and found that at final follow-up aER improved from 4
not find differences in aIR, aFE, passive forward elevation,
to 27
(P <.001) and ER lag sign was successfully elimi- and aER with the elbow at 90
of abduction.25 There was
nated in 25 of 32 shoulders.20 Shi et al reported on 21 also no difference in patient-reported outcomes, however,
patients with a minimum 2-year follow-up after RTSA with they did find resolution of the Hornblower sign post-
LDT.21 The authors reported forward flexion increased operatively in 58.3% of patients in the control group and
from 50
to 120
, aER with the arm at the side increased 73.3% of those in the treatment group.26 In addition to
1020 J.M. Wiater et al.

controversy over the magnitude of clinical benefit obtained Weaknesses of this study include its nonrandomized
by LDT, the additional procedure increases the overall design, in which patients were retrospectively selected from
surgery time, is technically demanding, and risks potential a prospectively collected data registry, likely introducing
nerve injury, stress risers in bone from drill holes, and some selection bias into the study. In addition, all proced-
potential loss of IR or decreased potential IR gains. ures were performed by a single surgeon. While this design
In the current study, we used a single incision technique to strengthens internal validity of the study, it may reduce the
transfer exclusively the LDT, leaving the TMT intact. We generalizability of the results. There was a small baseline
believe this technique minimizes IR weakness, particularly difference in preoperative aER between the groups, which
when the subscapularis tendon is not repaired. In our study could be a confounding factor. However, this difference
design, the addition of a control group with similar aER was small (<8
) and likely clinically insignificant, and no
dysfunction allows for a more meaningful analysis regarding differences were identified for any patient-reported
the effect of LDT in these patients. The procedures were done outcome measures preoperatively. Since both groups had an
by a single surgeon, using the same technique consistently. average aER below 0
at baseline, this difference should
Although the LDT group did gain an average of 22 degrees of have minimal impact on results interpretation. Additional
aER, this was not significantly different than the NT group’s weaknesses include the addition of 2 different glenosphere
gain of 17
(P > .05). Additionally, the secondary outcome designs in the LDT group. A separate sub analysis, how-
measures were similar preoperatively and at final follow-up ever, showed that the hybrid construct did not result in
between groups, along with all other subjective patient different outcomes, possibly due to the small difference in
outcome measures, save for aIR. One possible reason for the glenoid lateral offset between the 2 designs (16.7 mm DJO
slight increase in aER in the NT group may be related to the vs. 11.5 mm Zimmer).25 However, the sub analysis was
glenosphere size utilized.3 M€ uller et al reported midterm likely underpowered to detect a difference due to prosthetic
results on 68 patients who underwent reverse shoulder design.
arthroplasty with glenosphere sizes of 36 mm and 44 mm.18
At 1 year, the group who received the size 44 mm glenosphere
achieved an average increase of 12
ER.18 Berglund et al Conclusion
demonstrated that patients with preoperative ER deficit could
achieve improved ER after reverse shoulder arthroplasty Patients with ER deficit undergoing reverse total
through lateralization of the glenosphere center of rotation shoulder arthroplasty for severe rotator cuff deficiency
without the use of LDT.4 with and without glenohumeral arthritis do not have
The only significant finding in the current study was an significantly improved aER or patient-reported outcome
improvement in aIR in the NT group (þ0.77 vertebral measures with concomitant LDT.
levels), compared to a slight decrease in aIR in the LDT
group (0.29 vertebral levels). Boileau et al reported
decreased IR strength after latissimus dorsi and teres major
tendon transfer with reverse shoulder arthroplasty.6,9 This
Disclaimers:
may be due to the loss of the IR function of the latissimus
Funding: No funding was disclosed by the authors.
and teres major by converting them to external rotators, the
Conflicts of interest: J. Michael Wiater reports personal
expected loss of IR inherent to the design of the prosthesis,
fees from Biomet and Depuy, A Johnson and Johnson
or as a result of the over-tensioning the transfer.6 In our
Company, stock options from Eleven Blade Solutions,
series, the senior author attempted to maximize ER in the
paid consultant and stock options from Catalyst Ortho-
presence of a positive ER lag sign and limited ER by not
Science, stock options from Coracoid Solutions, stock
transferring the TMT with the LDT, and by not repairing
options from Hoolux Medical, stock options from Ignite
the subscapularis tendon. In the LDT group, the lack of
Orthopedics, paid consultant for Lima Corporate, stock
repair of the subscapularis tendon, in combination with loss
options from Mpirik, intellectual property royalties from
of the latissimus dorsi function as an internal rotator, may
Innomed, intellectual property royalties from Smith and
compromise IR while attempting to improve ER. Further-
Nephew, nonfinancial research support from Synthes,
more, a tenodesis effect of the transfer may contribute to
nonfinancial research support from Tornier, personal
diminished aIR.10 This may explain the difference in aIR
fees, and nonfinancial support from Zimmer, outside the
gain over baseline between groups, although the changes in
submitted work. The other authors, their immediate
both groups were small and likely not clinically significant.
families, and any research foundation with which they
The gains in aER for patients in this study (22
) are lower
are affiliated have not received any financial payments
than some previously described (range 7-32
).5,10,20,21 A
or other benefits from any commercial entity related to
possible reason for this is that only the latissimus dorsi was
the subject of this article.
transferred, while the teres major was preserved.
Concomitant latissimus dorsi tendon transfer for RTSA 1021

remaining rotator cuff. J Orthop Surg Res 2011;6:42. https://doi.org/

References 10.1186/1749-799X-6-42
1. Ackland DC, Richardson M, Pandy MG. Axial rotation moment arms 15. Huskisson EC. Measurement of pain. Lancet 1974;2:1127-31.
of the shoulder musculature after reverse total shoulder arthroplasty. J 16. Langer JS, Sueoka SS, Wang AA. The importance of shoulder external
Bone Joint Surg Am 2012;94:1886-95. https://doi.org/10.2106/JBJS.J. rotation in activities of daily living: improving outcomes in traumatic
01861 brachial plexus palsy. J Hand Surg Am 2012;37:1430-6. https://doi.
2. Aoki M, Okamura K, Fukushima S, Takahashi T, Ogino T. Transfer of org/10.1016/j.jhsa.2012.04.011
latissimus dorsi for irreparable rotator-cuff tears. J Bone Joint Surg Br 17. Michener LA, McClure PW, Sennett BJ. American Shoulder and
1996;78:761-6. Elbow Surgeons Standardized shoulder Assessment Form, patient self-
3. Berglund DD, Rosas S, Triplet JJ, Kurowicki J, Horn B, Levy JC. report section: reliability, validity, and responsiveness. J Shoulder
Restoration of external rotation following reverse shoulder arthro- Elbow Surg 2002;11:587-94. https://doi.org/10.1067/mse.2002.
plasty without latissimus dorsi transfer. JB JS Open Access 2018;3: 127096
e0054. https://doi.org/10.2106/JBJS.OA.17.00054 18. M€uller AM, Born M, Jung C, Flury M, Kolling C, Schwyzer HK, et al.
4. Birmingham PM, Neviaser RJ. Outcome of latissimus dorsi transfer as Glenosphere size in reverse shoulder arthroplasty: is larger better for
a salvage procedure for failed rotator cuff repair with loss of elevation. external rotation and abduction strength? J Shoulder Elbow Surg 2018;
J Shoulder Elbow Surg 2008;17:871-4. https://doi.org/10.1016/j.jse. 27:44-52. https://doi.org/10.1016/j.jse.2017.06.002
2008.04.007 19. Nolan BM, Ankerson E, Wiater JM. Reverse total shoulder arthro-
5. Boileau P, Chuinard C, Roussanne Y, Neyton L, Trojani C. Modified plasty improves function in cuff tear arthropathy. Clin Orthop Relat
latissimus dorsi and teres major transfer through a single delto- Res 2011;469:2476-82. https://doi.org/10.1007/s11999-010-1683-z
pectoral approach for external rotation deficit of the shoulder: as an 20. Puskas GJ, Catanzaro S, Gerber C. Clinical outcome of reverse total
isolated procedure or with a reverse arthroplasty. J Shoulder Elbow shoulder arthroplasty combined with latissimus dorsi transfer for the
Surg 2007;16:671-82. https://doi.org/10.1016/j.jse.2007.02.127 treatment of chronic combined pseudoparesis of elevation and external
6. Boileau P, Rumian AP, Zumstein MA. Reversed shoulder arthroplasty rotation of the shoulder. J Shoulder Elbow Surg 2014;23:49-57. https://
with modified L’Episcopo for combined loss of active elevation and doi.org/10.1016/j.jse.2013.04.008
external rotation. J Shoulder Elbow Surg 2010;19:20-30. https://doi. 21. Shi LL, Cahill KE, Ek ET, Tompson JD, Higgins LD, Warner JJP.
org/10.1016/j.jse.2009.12.011 Latissimus dorsi and teres major transfer with reverse shoulder
7. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer award 2005: arthroplasty restores active motion and reduces pain for poster-
the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, osuperior cuff dysfunction. Clin Orthop Relat Res 2015;473:3212-7.
fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg https://doi.org/10.1007/s11999-015-4433-4
2006;15:527-40. https://doi.org/10.1016/j.jse.2006.01.003 22. Simovitch RW, Helmy N, Zumstein MA, Gerber C. Impact of fatty
8. Boulahia A, Edwards TB, Walch G, Baratta RV. Early results of a infiltration of the teres minor muscle on the outcome of reverse total
reverse design prosthesis in the treatment of arthritis of the shoulder in shoulder arthroplasty. J Bone Joint Surg Am 2007;89:934-9. https://
elderly patients with a large rotator cuff tear. Orthopedics 2002;25: doi.org/10.2106/JBJS.F.01075
129-33. https://doi.org/10.3928/0147-7447-20020201-16 23. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Mole D.
9. Flury M, Kwisda S, Kolling C, Audige L. Latissimus dorsi muscle Grammont inverted total shoulder arthroplasty in the treatment of
transfer reduces external rotation deficit at the cost of internal rotation glenohumeral osteoarthritis with massive rupture of the cuff. Results
in reverse shoulder arthroplasty patients: a cohort study. J Shoulder of a multicentre study of 80 shoulders. J Bone Joint Surg Br 2004;86:
Elbow Surg 2019;28:56-64. https://doi.org/10.1016/j.jse.2018.06.032 388-95. https://doi.org/10.1302/0301-620X.86B3.14024
10. Gerber C, Pennington SD, Lingenfelter EJ, Sukthankar A. Reverse 24. Werner CML, Steinmann PA, Gilbart M, Gerber C. Treatment of
Delta-III total shoulder replacement combined with latissimus dorsi painful pseudoparesis due to irreparable rotator cuff dysfunction with
transfer. A preliminary report. J Bone Joint Surg Am 2007;89:940-7. the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone
https://doi.org/10.2106/JBJS.F.00955 Joint Surg Am 2005;87:1476-86. https://doi.org/10.2106/JBJS.D.
11. Gerber C, Vinh TS, Hertel R, Hess CW. Latissimus dorsi transfer for 02342
the treatment of massive tears of the rotator cuff. A preliminary report. 25. Werthel JD, Walch G, Vegehan E, Deransart P, Sanchez-Sotelo J,
Clin Orthop Relat Res 1988;232:51-61. Valenti P. Lateralization in reverse shoulder arthroplasty: a descriptive
12. Gilbart MK, Gerber C. Comparison of the Subjective Shoulder Value analysis of different implants in current practice. Int Orthopaedics
and the Constant score. J Shoulder Elbow Surg 2007;16:717-21. 2019;43:2349-60. https://doi.org/10.1007/s00264-019-04365-3
https://doi.org/10.1016/j.jse.2007.02.123 26. Young BL, Connor PM, Schiffern SC, Roberts KM, Hamid N.
13. Habermeyer P, Magosch P, Rudolph T, Lichtenberg S, Liem D. Reverse shoulder arthroplasty with and without latissimus and teres
Transfer of the tendon of latissimus dorsi for the treatment of massive major transfer for patients with combined loss of elevation and
tears of the rotator cuff: a new single-incision technique. J Bone Joint external rotation: a prospective, randomized investigation. J Shoul-
Surg Br 2006;88:208-12. https://doi.org/10.1302/0301-620X.88B2. der Elbow Surg 2020;29:874-81. https://doi.org/10.1016/j.jse.2019.
16830 12.024
14. Herrmann S, K€ onig C, Heller M, Perka C, Greiner S. Reverse shoulder 27. Zachary RB. Transplantation of teres major and latissimus dorsi for
arthroplasty leads to significant biomechanical changes in the loss of external rotation at shoulder. Lancet 1947;2:757.