Improved long-term functional outcome after a latissimus dorsi transfer with or without subscapularis muscle lengthening or release


brachial plexus birth injury ; latissimus dorsi transfer ; subscapularis lengthening ; subscapularis release ; long-term follow-up

Published online: Jun 15 2021

Stijn De Joode, Lazin Germawi, Martijn Schotanus, Juul Van der Lingen, Tom Van Mulken, Ferry Van Nie, Steven Samijo

From the Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, location Heerlen, the Netherlands


A brachial plexus birth injury (BPBI) can lead to a limited shoulder function, especially abduction and external rotation. One of the treatment options to restore those shoulder functions is a latissimus dorsi transfer (LDT). The aim of this study is to analyze long-term functional outcome after a single LDT and compare these results with LDT combined with subscapularis muscle lengthening (SSL) or subscapularis muscle release (SSR).

This cohort study included 39 patients (≤12 years old) with one-sided BPBI. All patients had an inter- nal rotation- and adduction contracture without glenohumeral joint deformity. A LDT was performed with or without SSL or SSR, resulting in 3 patient study groups. Demographic data and pre- and post- operative Mallet scores were collected and analysed for each group.

The median age was 4.0 years (IQR 3.1) and there were no differences in patient demographics. In all patients surgery improved external rotation and overall shoulder function, at 9.8 years follow-up. Also, the total Mallet score increased significantly with 1.7 (p=0.001) in our (entire) study cohort.

A LDT, with a SSL or SSR in case of an intra-operative internal contracture, improves shoulder function and preserves external rotation in patients (≤12 years old) with BPBI, at a follow up of 9.8 years.