arthroscopic lat dorsi transfer 2017
TRANSCRIPT
@thearmclinic
Arthroscopic LDT
Lennard Funk
@thearmclinic
Acknowledgements• LaFosse, 2002 • Grimberg, 2011
• Gerber• Gervasi
@thearmclinic
Cumbrian farmer
@thearmclinic
Indication for tendon transfer
• MRCT with Weakness• Functional strength loss +/- pain
@thearmclinic
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
@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
Position
@thearmclinic
@thearmclinic
@thearmclinic
@thearmclinic
@thearmclinic
@thearmclinic
Portals
viewing
Anchorinsertion
Working
Suture Retrieval
@thearmclinic
@thearmclinic
Posterior Release
@thearmclinic
Posterior Release
@thearmclinic
Humerus Prep
@thearmclinic
Suture retrieval
@thearmclinic
Tendon Retrieval
@thearmclinic
Tendon Retrieval
@thearmclinic
Tendon Fixation
@thearmclinic
Final Fixation
@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 !!!
@thearmclinic
6 Months Post-op