Outcomes of transfer of latissimus dorsi and teres major on the rotator cuff with or without anterior release in children with obstetric paralysis: A retrospective study

Abstract

Aim. Latissimus dorsi and teres major (LDTM) tendon transfer is frequently performed in patients with obstetrical brachial plexus palsy (OBPP). Adding an anterior release to a LD-TM transfer might help decrease residual internal rotation contractures. The aim of this study was to evaluate the results of LDTM transfer with or without anterior release and to evaluate the influence of additional anterior release on shoulder motion in patients with OBPP. Methods. Twenty-two patients with a mean age of 8.1±4.7 years, who underwent LD-TM tendon transfers, were included in the study. In nine patients LD-TM transfer with an additional anterior release procedure (pectoralis major ± subscapularis release) was performed, whereas in 13 patients only LD-TM tendon transfer was performed. Shoulder abduction and external rotation were assessed according to Gilbert's classification system and also by using goniometric method, and internal rotation according to the Mallet scoring system. Results. The mean follow-up period was 51±37.3 months. Range of motion in both abduction and external rotation increased significantly in all patients. Gilbert score also increased significantly in all patients (P=0.000). When the two groups were compared, there were no significant differences besides age. The patients with anterior release were significantly older than the patients without anterior release (P=0.014). Conclusion. LD-TM transfer is an effective tecnique and can improve shoulder motions in patients with OBPP. LD-TM tendon transfers at an early age seem to prevent internal rotation contracture of the shoulder with a decrease in need for anterior release.