arthroscopic lat dorsi transfer 2017

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Arthroscopic LDT

Lennard Funk

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Acknowledgements• LaFosse, 2002 • Grimberg, 2011

• Gerber• Gervasi

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Cumbrian farmer

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Indication for tendon transfer

• MRCT with Weakness• Functional strength loss +/- pain

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Pre-requisites of Transfer1. Intact deltoid

2. Intact Subscapularis - maintain force-couple

3. No Pseudoparalysis

4. Good bone - fixation

5. Compliant patient (young active)

6. Teres Minor Intact

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

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Principles of the technique• Open: – Harvest Tendon– Mobilise tendon

• Arthroscopy: – Prepare surfaces– Develop track– Transfer tendon– Fixation

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Position

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Portals

viewing

Anchorinsertion

Working

Suture Retrieval

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Posterior Release

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Posterior Release

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Humerus Prep

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Suture retrieval

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Tendon Retrieval

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Tendon Retrieval

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Tendon Fixation

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Final Fixation

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Post-Surgery

• ER Brace - comfort only• Pain Management• Limit NSAIDs• Cold Compression• Wound Care• Early Rehab

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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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6 Months Post-op