Institut Locomoteur de l'Ouest, Saint-Grégoire, France.
Chirurgie Orthopédique et Traumatologique, Hôpital Pierre-Paul Riquet, Toulouse, France.
J Shoulder Elbow Surg. 2021 Feb;30(2):282-289. doi: 10.1016/j.jse.2020.06.002. Epub 2020 Jun 27.
There is limited evidence on clinical outcomes of arthroscopic partial repair (APR) and latissimus dorsi tendon transfer (LDTT) for posterosuperior massive rotator cuff tears (mRCTs). We aimed to compare clinical outcomes of APR and LDTT for partially repairable posterosuperior mRCTs and to determine whether outcomes differ among tears that involve the teres minor.
We retrieved the records of 112 consecutive patients with mRCTs deemed partially repairable due to fatty infiltration (FI) stage ≥3 in one or more rotator cuff muscles. Of the tears, 12 involved the subscapularis, 32 were managed conservatively, 14 were treated by reverse shoulder arthroplasty, and 7 were treated by stand-alone biceps tenotomy. Of the remaining 47 shoulders, 26 underwent APR and 21 underwent LDTT. At a minimum of 12 months, we recorded complications, active forward elevation, external rotation, the Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and Simple Shoulder Test (SST) score.
No significant differences between the APR and LDTT groups were found in terms of follow-up (23.4 ± 3.5 months vs. 22.1 ± 4.1 months, P = .242), Constant-Murley score (64.8 ± 13.7 vs. 58.9 ± 20.0, P = .622), ASES score (78.3 ± 19.3 vs. 74.4 ± 14.5, P = .128), active forward elevation (158.1° ± 19.4° vs. 142.8° ± 49.1°, P = .698), or external rotation (33.3° ± 17.4° vs. 32.2° ± 20.9°, P = .752). By contrast, the APR group had a higher SSV (73.3 ± 17.5 vs. 59.5 ± 20.0, P = .010), and SST score (8.3 ± 2.4 vs. 6.4 ± 3.0, P = .024). Univariable analysis revealed that advanced FI of the teres minor compromised Constant-Murley scores (β = -25.8, P = .001) and tended to compromise ASES scores (β = -15.2, P = .062). Multivariable analysis corroborated that advanced FI of the teres minor compromised Constant-Murley scores (β = -26.9, P = .001) and tended to compromise ASES scores (β = -16.5, P = .058).
Both APR and LDTT granted similar early clinical outcomes for partially repairable posterosuperior mRCTs, regardless whether the teres minor was intact or torn. Advanced FI of the teres minor was the only independent factor associated with outcomes, as it significantly compromised Constant-Murley scores and tended to compromise ASES scores.
对于 posterosuperior massive rotator cuff tears (mRCTs)，关节镜下部分修复（APR）和 Latissimus dorsi tendon transfer (LDTT) 的临床结果证据有限。我们旨在比较 APR 和 LDTT 治疗部分可修复的 posterosuperior mRCTs 的临床结果，并确定在涉及teres minor 的撕裂中结果是否存在差异。
我们检索了 112 例因一个或多个肩袖肌肉脂肪浸润（FI）≥3 期而被认为部分可修复的 mRCTs 的连续患者记录。这些撕裂中，12 例涉及肩胛下肌，32 例接受保守治疗，14 例接受反向肩关节置换术治疗，7 例接受单独肱二头肌肌腱切断术治疗。在剩余的 47 个肩膀中，26 个接受了 APR，21 个接受了 LDTT。至少 12 个月后，我们记录了并发症、主动前向抬高、外展、Constant-Murley 评分、美国肩肘外科医生（ASES）评分、主观肩部价值（SSV）和简单肩部测试（SST）评分。
APR 和 LDTT 组在随访时间（23.4±3.5 个月 vs. 22.1±4.1 个月，P=0.242）、Constant-Murley 评分（64.8±13.7 vs. 58.9±20.0，P=0.622）、ASES 评分（78.3±19.3 vs. 74.4±14.5，P=0.128）、主动前向抬高（158.1°±19.4° vs. 142.8°±49.1°，P=0.698）和外展（33.3°±17.4° vs. 32.2°±20.9°，P=0.752）方面无显著差异。相比之下，APR 组的 SSV（73.3±17.5 vs. 59.5±20.0，P=0.010）和 SST 评分（8.3±2.4 vs. 6.4±3.0，P=0.024）更高。单变量分析显示，teres minor 的高级 FI 会降低 Constant-Murley 评分（β=-25.8，P=0.001），且倾向于降低 ASES 评分（β=-15.2，P=0.062）。多变量分析证实，teres minor 的高级 FI 会降低 Constant-Murley 评分（β=-26.9，P=0.001），且倾向于降低 ASES 评分（β=-16.5，P=0.058）。
APR 和 LDTT 为部分可修复的 posterosuperior mRCTs 提供了相似的早期临床结果，无论teres minor 是否完整或撕裂。teres minor 的高级 FI 是唯一与结果相关的独立因素，因为它显著降低了 Constant-Murley 评分，且倾向于降低 ASES 评分。
