Lopez-Fernandez Vanesa, Mariaux Sandrine, Lafosse Laurent, Lafosse Thibault
Hand, UpperLimb, Brachial Plexus, and Microsurgery Unit, Clinique Générale d'Annecy, Annecy, France.
Service of Orthopedics and Traumatology, Collombey-Muraz, Switzerland.
Arthrosc Tech. 2022 Apr 22;11(5):e755-e762. doi: 10.1016/j.eats.2021.12.031. eCollection 2022 May.
Latissimus dorsi (LD) transfer is a reliable treatment option for irreparable posterosuperior (PS) rotator cuff tears in young and active patients that need to recover the range of motion for their daily living activities. The technique starts with an arthroscopic assessment of the tear. The next step is the mini-open stage for muscle release from the subcutaneous layer of the skin, the teres major (TM), the triceps, and the lateral border and inferior angle of the scapula. Later, the scope is used to prepare the footprint (arthroscopy) and for the release and the harvest of the tendon (endoscopy), taking care not to detach the TM and not to damage the radial nerve. A grasper is used to push the LD to its correct path medial to the triceps. After that the same instrument is placed from the anterolateral and the anterior arthroscopic portals toward the mini-open incision to catch the sutures previously loaded on the LD tendon with Krackow stitches. The LD is transferred to the greater tuberosity and is attached with one medial and one lateral knotless anchors. A third point of fixation enables a partial RC repair and ensures a surface of bone to tendon healing.
背阔肌（LD）转移术是一种可靠的治疗方法，适用于年轻且活跃的患者中无法修复的后上（PS）肩袖撕裂，这些患者需要恢复日常生活活动的活动范围。该技术始于对撕裂进行关节镜评估。下一步是迷你切开阶段，用于从皮肤皮下层、大圆肌（TM）、三头肌以及肩胛骨外侧缘和下角松解肌肉。之后，使用关节镜准备足迹（关节镜检查）并用于肌腱的松解和取材（内镜检查），注意不要分离TM且不要损伤桡神经。用抓钳将背阔肌推至三头肌内侧的正确路径。之后，将同一器械从前外侧和前方关节镜入路朝向迷你切开切口放置，以抓住先前用Krackow缝线加载在背阔肌腱上的缝线。将背阔肌转移至大结节，并用一个内侧和一个外侧无结锚钉固定。第三个固定点可实现部分肩袖修复，并确保骨与肌腱愈合的表面。
