Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
J Shoulder Elbow Surg. 2021 Nov;30(11):e676-e688. doi: 10.1016/j.jse.2021.03.149. Epub 2021 Apr 17.
With progress in arthroscopic surgery, latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears (RCTs) has become a reliable all-arthroscopic or arthroscopically assisted procedure. The mid-term results of arthroscopically assisted latissimus dorsi transfer (aLDT) are scarce in the literature. The purpose of this study was to report our clinical and radiographic mid-term results of aLDT for irreparable posterosuperior RCTs.
Thirty-one consecutive patients with a mean age of 55.5 years (range, 38-73 years) at the time of aLDT were evaluated after a mean of 3.5 years (range, 2-5 years). All patients had irreparable, full-thickness tears of at least the complete supraspinatus, with or without infraspinatus tendons, and 12 patients (39%) had undergone previous rotator cuff repair (RCR). A concomitant upper-third subscapularis repair was needed at the time of aLDT in 7 patients (23%). Mid-term results were assessed clinically and radiographically (including magnetic resonance imaging).
At final follow-up, 4 patients with failure (13%) had undergone revision to reverse total shoulder arthroplasty (RTSA) essentially for untreatable pain. Patients with revision to RTSA had significantly higher preoperative pain levels (Constant pain score, 6 points vs. 11 points; P = .032) and lower Constant activity scores (2 points vs. 5 points, P = .017) than the remaining 27 patients. Patients with failed previous RCRs had significantly inferior results compared with patients without previous repair (mean Subjective Shoulder Value, 67% vs. 88%; P = .035). For the 27 patients without revision, the mean relative Constant score improved from 63% to 76% (P = .032), the Constant pain score, from 10.5 to 12.7 points (P = .012), and the Subjective Shoulder Value, from 43% to 77% (P < .001). Significant progression of glenohumeral arthropathy by 2 or more grades according to the Hamada classification was observed in 13 of the 27 patients (48%), but there was no significant difference in clinical outcomes between the patients with arthropathy (n = 13) and those without it (n = 14, P = .923).
The mid-term results of aLDT for irreparable posterosuperior RCTs were associated with significant improvements in objective and subjective outcome measures. The failure rate leading to conversion to RTSA was relatively high in this cohort. The failures were associated with unusually intense pain in low-demand individuals and/or revision of failed RCR. Long-term results of aLDT are needed to evaluate the effect of this procedure on the progression of osteoarthritis.
随着关节镜手术的进步，Latissimus dorsi 转移术已成为治疗不可修复的后上肩袖撕裂（RCTs）的可靠全关节镜或关节镜辅助手术。关节镜辅助 Latissimus dorsi 转移术（aLDT）的中期结果在文献中很少见。本研究的目的是报告我们对不可修复的后上肩袖撕裂的关节镜辅助 Latissimus dorsi 转移术（aLDT）的临床和影像学中期结果。
31 例患者平均年龄 55.5 岁（范围 38-73 岁），在接受 aLDT 后平均随访 3.5 年（范围 2-5 年）。所有患者均有不可修复的全层撕裂，至少完全覆盖冈上肌，伴有或不伴有冈下肌腱，12 例患者（39%）曾接受过肩袖修复（RCR）。7 例患者（23%）在接受 aLDT 时需要同时进行上三分之一肩胛下肌修复。中期结果通过临床和影像学（包括磁共振成像）进行评估。
在最终随访时，4 例（13%）失败患者因无法治疗的疼痛而接受了反向全肩关节置换术（RTSA）的翻修。需要进行 RTSA 翻修的患者术前疼痛水平显著更高（Constant 疼痛评分，6 分 vs. 11 分；P =.032），Constant 活动评分显著更低（2 分 vs. 5 分，P =.017），而其余 27 例患者的术前疼痛水平和 Constant 活动评分无显著差异。与无既往修复的患者相比，既往有失败 RCR 患者的结果明显较差（平均主观肩部值，67% vs. 88%；P =.035）。在 27 例未行翻修的患者中，相对 Constant 评分从 63%提高到 76%（P =.032），Constant 疼痛评分从 10.5 分提高到 12.7 分（P =.012），主观肩部值从 43%提高到 77%（P <.001）。根据 Hamada 分类，27 例患者中有 13 例（48%）出现 2 级或以上的肩肱关节炎进展，但在有或没有关节炎的患者之间，临床结果没有显著差异（关节炎患者，n = 13；无关节炎患者，n = 14，P =.923）。
不可修复的后上肩袖撕裂的关节镜辅助 Latissimus dorsi 转移术的中期结果与客观和主观结果测量的显著改善相关。该队列中，需要翻修为 RTSA 的失败率相对较高。失败与低需求个体的异常剧烈疼痛和/或失败的 RCR 修复有关。需要进行长期的 aLDT 结果评估，以评估该手术对骨关节炎进展的影响。
