Kany Jean, Siala Mahdi, Werthel Jean David, Grimberg Jean
Clinique De l'Union, Ramsay Santé, Saint Jean, France.
Hôpital Ambroise Pare, Paris, France.
J Shoulder Elbow Surg. 2024 Apr;33(4):e198-e207. doi: 10.1016/j.jse.2023.08.007. Epub 2023 Sep 27.
To compare clinical outcomes and complication rates of full arthroscopic latissimus dorsi tendon transfer (LDTT) vs. arthroscopically assisted LDTT, for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs) in shoulders that had failed rotator cuff repair (RCR).
We evaluated a continuous series of 191 patients who underwent LDTT over 4 consecutive years. A total of 107 patients did not have previous shoulder surgery, leaving 84 patients who had prior surgical procedures. All procedures performed over the first 2 years were arthroscopically assisted (n = 48), whereas all procedures performed over the last 2 years were full arthroscopic (n = 36). We noted all complications, as well as clinical scores and range of motion at ≥24 months. To enable direct comparison between the 2 techniques, propensity score matching was used to obtain 2 groups with equivalent age, sex, and follow-up.
Compared with the 48 patients who underwent arthroscopically assisted LDTT, the 36 patients who underwent full arthroscopic LDTT had comparable complications (13% vs. 11%) and conversions to RSA (8.3% vs. 5.6%). Propensity score matching resulted in 2 groups, each comprising 31 patients, which had similar outcomes in terms of clinical scores (except mobility component of Constant score, which was better following fully arthroscopic LDTT; P = .037) and range of motion at a minimum follow-up of 2 years.
At a minimum follow-up of 24 months, for the treatment of irreparable posterosuperior mRCTs in shoulders that had surgical antecedents, full arthroscopic LDTT had significantly better mobility component of the Constant score than arthroscopically assisted LDTT, although there were no significant differences in the other clinical or functional outcomes. Arthroscopically assisted LDTT and full arthroscopic LDTT had comparable rates of complications (8.3% vs. 13%) and conversion to RSA (5.6% vs. 8.3%).
比较全关节镜下背阔肌肌腱转位术（LDTT）与关节镜辅助下LDTT治疗肩袖修复（RCR）失败的不可修复的后上巨大肩袖撕裂（mRCTs）的临床疗效和并发症发生率。
我们评估了连续4年接受LDTT的191例患者。共有107例患者此前未接受过肩部手术，其余84例患者曾接受过手术。前2年进行的所有手术均为关节镜辅助手术（n = 48），而后2年进行的所有手术均为全关节镜手术（n = 36）。我们记录了所有并发症以及≥24个月时的临床评分和活动范围。为了能够直接比较这两种技术，采用倾向评分匹配法获得年龄、性别和随访时间相当的两组患者。
与48例接受关节镜辅助LDTT的患者相比，36例接受全关节镜LDTT的患者并发症发生率相当（13%对11%），转为反式肩关节置换术（RSA）的比例相当（8.3%对5.6%）。倾向评分匹配后得到两组，每组31例患者，在临床评分（除Constant评分的活动度部分，全关节镜LDTT后的该部分评分更好；P = 0.037）和至少2年的最小随访活动范围方面结果相似。
在至少24个月的随访中，对于治疗有手术史的肩部不可修复的后上mRCTs，全关节镜LDTT的Constant评分活动度部分明显优于关节镜辅助LDTT，尽管在其他临床或功能结果方面没有显著差异。关节镜辅助LDTT和全关节镜LDTT的并发症发生率相当（8.3%对13%），转为RSA的比例相当（5.6%对8.3%）。
