Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, South Korea.
Bone Joint J. 2024 Sep 1;106-B(9):957-963. doi: 10.1302/0301-620X.106B9.BJJ-2024-0099.R1.
Favourable short-term outcomes have been reported following latissimus dorsi tendon transfer for patients with an irreparable subscapularis (SSC) tendon tear. The aim of this study was to investigate the long-term outcomes of this transfer in these patients.
This was a retrospective study involving 30 patients with an irreparable SSC tear and those with a SSC tear combined with a reparable supraspinatus tear, who underwent a latissimus dorsi tendon transfer. Clinical scores and active range of motion (aROM), SSC-specific physical examination and the rate of return to work were assessed. Radiological assessment included recording the acromiohumeral distance (AHD), the Hamada grade of cuff tear arthropathy and the integrity of the transferred tendon. Statistical analysis compared preoperative, short-term (two years), and final follow-up at a mean of 8.7 years (7 to 10).
There were significant improvements in clinical scores, in the range and strength of internal rotation and aROM compared with the preoperative values in the 26 patients (87%) who were available for long-term follow-up. These improvements were maintained between short- and long-term follow-ups. Although there was a decreased mean AHD of 7.3 mm (SD 1.5) and an increased mean Hamada grade of 1.7 (SD 0.5) at final follow-up, the rate of progression of cuff tear arthropathy remained low-grade. Comparison between the isolated SSC and combined SSC and reparable supraspinatus tear groups showed no significant differences. At final follow-up, one patient (3.8%) had undergone revision surgery to a reverse shoulder arthroplasty (RSA). No neurological complications were associated with the procedure.
Latissimus dorsi transfer for an irreparable SSC tendon tear resulted in a significant clinical improvement, particularly in pain, range and strength of internal rotation and aROM, which were maintained over a mean of 8.7 years following surgery. Given that this was a long-term outcome study, there was a low-grade progression in the rate of cuff tear arthropathy. Thus, the long-term clinical efficacy of latissimus dorsi tendon transfer in patients with irreparable SSC was confirmed as a joint-preserving procedure for these patients, suggesting it as an effective alternative to RSA in young, active patients without degenerative changes of the glenohumeral joint.
报道了背阔肌肌腱转位治疗不可修复肩胛下肌腱撕裂患者的短期结果良好。本研究的目的是调查这些患者转位的长期结果。
这是一项回顾性研究，共纳入 30 例不可修复的肩胛下肌腱撕裂和伴有可修复的冈上肌腱撕裂的患者，均行背阔肌肌腱转位。评估临床评分和主动活动范围（aROM）、肩胛下肌腱特异性体格检查和重返工作的比例。影像学评估包括记录肩峰肱骨关节距离（AHD）、肩袖撕裂性关节病的 Hamada 分级和转位肌腱的完整性。统计分析比较术前、短期（2 年）和最终随访（平均 8.7 年，7 至 10 年）。
26 例（87%）长期随访患者的临床评分、内旋范围和力量以及 aROM 与术前相比均有显著改善。这些改善在短期和长期随访之间保持不变。尽管最终随访时 AHD 均值降低 7.3mm（标准差 1.5），Hamada 分级均值增加 1.7（标准差 0.5），但肩袖撕裂性关节病的进展仍保持低级别。孤立性肩胛下肌腱组和合并可修复冈上肌腱撕裂组之间比较无显著差异。最终随访时，1 例（3.8%）患者行反向肩关节置换术（RSA）翻修手术。该手术无神经并发症。
对于不可修复的肩胛下肌腱撕裂，背阔肌转位可显著改善临床效果，尤其是疼痛、内旋范围和力量以及 aROM，这些在手术后平均 8.7 年的随访中得到维持。鉴于这是一项长期结果研究，肩袖撕裂性关节病的进展率较低。因此，证实了背阔肌肌腱转位治疗不可修复肩胛下肌腱的长期临床疗效为一种保留关节的手术方法，对于年轻、活跃且肱盂关节无退行性改变的患者，它是 RSA 的有效替代方法。
