Grimberg Jean, Kany Jean, Valenti Philippe, Amaravathi Rajkumar, Ramalingam Alagappan Thangamani
L'Institut de Recherché en Chirurgie Orthopédique et Sportive, Paris, France.
Clinique de l'Union, Saint Jean, France.
Arthroscopy. 2015 Apr;31(4):599-607.e1. doi: 10.1016/j.arthro.2014.10.005. Epub 2014 Dec 10.
To evaluate, in a multicenter, prospective study, the clinical, magnetic resonance imaging (MRI), and radiologic results of arthroscopic-assisted latissimus dorsi (LD) tendon transfer for irreparable posterosuperior rotator cuff tears; and to assess the influence of perioperative data on clinical results.
Fifty-five patients with irreparable tears of at least the supraspinatus and infraspinatus tendons were managed with arthroscopic-assisted LD tendon transfer and reviewed clinically, with standardized radiographs and MRI, after a mean of 29 months. Outcome measures included the Constant score and the Subjective Shoulder Value. The osteoarthritic stage and acromiohumeral distance were measured on standardized radiographs, and the transferred tendon aspect was evaluated on MRI.
Thirty patients had already undergone 1 or more previous surgical procedures. The mean Subjective Shoulder Value increased from 26% preoperatively to 71% postoperatively. The Constant score improved from 37 preoperatively to 65.4 postoperatively. The pain score increased from 1.7 preoperatively to 12.6 postoperatively; the activity score, from 6.4 to 13.8; active forward flexion, from 134° to 157°; active abduction, from 67° to 92.5°; active external rotation, from 29° to 41.5°; and abduction strength, from 1.4 kg to 4.8 kg. The only statistically significant factor negatively influencing the Constant score was previous surgery. Four patients had a ruptured LD tendon on MRI follow-up at 1 year. There was no statistical difference between preoperative and final follow-up acromiohumeral distance. There was no increase in osteoarthritic stage.
Arthroscopic-assisted LD tendon transfer improves shoulder pain and function in patients with irreparable posterosuperior cuff tears, with similar clinical and radiologic results compared with results of published series using open techniques. Patients with a history of surgery had lower Constant scores compared with non-previously operated patients.
Level IV, therapeutic case series.
在一项多中心前瞻性研究中，评估关节镜辅助下背阔肌（LD）肌腱转移治疗不可修复的肩袖后上部撕裂的临床、磁共振成像（MRI）和放射学结果；并评估围手术期数据对临床结果的影响。
55例至少冈上肌和冈下肌肌腱不可修复撕裂的患者接受了关节镜辅助下LD肌腱转移治疗，并在平均29个月后进行了临床复查、标准化X线片和MRI检查。结果指标包括Constant评分和主观肩关节评分。在标准化X线片上测量骨关节炎分期和肩峰下间隙，在MRI上评估转移肌腱情况。
30例患者此前已接受过1次或更多次手术。主观肩关节评分从术前的26%提高到术后的71%。Constant评分从术前的37分提高到术后的65.4分。疼痛评分从术前的1.7分提高到术后的12.6分；活动评分从6.4分提高到13.8分；主动前屈从134°提高到157°；主动外展从67°提高到92.5°；主动外旋从29°提高到41.5°；外展力量从1.4kg提高到4.8kg。唯一对Constant评分有统计学显著负面影响的因素是既往手术史。4例患者在术后1年的MRI随访中出现LD肌腱断裂。术前和最终随访时的肩峰下间隙无统计学差异。骨关节炎分期无增加。
关节镜辅助下LD肌腱转移可改善不可修复的肩袖后上部撕裂患者的肩部疼痛和功能，与采用开放技术的已发表系列研究结果相比，临床和放射学结果相似。有手术史的患者与未接受过手术的患者相比，Constant评分较低。
IV级，治疗性病例系列。
