Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Korea.
Clin Orthop Surg. 2024 Oct;16(5):761-773. doi: 10.4055/cios24115. Epub 2024 Sep 13.
Irreparable anterosuperior rotator cuff tears (IASRCTs) present significant challenges, especially in young, active patients with limited joint-preserving options. Recently, latissimus dorsi (LD) transfer and combined latissimus dorsi and teres major (LDTM) transfer have gained attention as a potential surgical option. We aimed to compare the clinical and radiological outcomes of LD versus combined LDTM transfer in IASRCTs.
In this retrospective comparative study, 53 patients with IASRCTs were analyzed after undergoing either LD transfer attached to lesser tuberosity (LT) (LD group, n = 23) or combined LDTM transfer attached to greater tuberosity (GT) (LDTM group, n = 30). Clinical evaluations included the visual analog scale score for pain, active shoulder range of motion (ROM), University of California Los Angeles Shoulder Score, American Shoulder and Elbow Surgeons score, activities of daily living that require active internal rotation (ADLIR) scores, and subscapularis (SSC)-specific examinations. Radiographic analyses involved assessing acromiohumeral distance (AHD), Hamada grade, the rate of anterior glenohumeral subluxation reduction, and integrity of the transferred tendon.
Postoperatively, both groups demonstrated significant improvements in pain and clinical scores ( < 0.001). At the 2-year follow-up, the LDTM group showed superior internal rotation strength ( < 0.001), ADLIR score ( = 0.017), and SSC-specific physical examination results (belly-press, = 0.027; bear-hug, = 0.031; lift-off, = 0.032). No significant changes in AHD or Hamada grade were observed in either group. At final follow-up, no significant differences were found between the 2 groups in terms of AHD ( = 0.539) and Hamada grade ( = 0.974). Although preoperative anterior glenohumeral subluxation was improved in both groups, the LDTM group showed a statistically significantly higher rate of restoration compared to the LD group ( = 0.015).
While both LD and combined LDTM transfers for IASRCTs improved postoperative pain relief, clinical scores, and active ROM, the combined LDTM transfer attached to GT was superior to LD transfer attached to LT in terms of internal rotational strength, ADLIR score, and SSC-specific examinations. Neither group showed significant progress in cuff tear arthropathy or decreased AHD at 2-year follow-up; however, the combined LDTM transfer notably improved preoperative anterior glenohumeral subluxation.
不可修复的前上方肩袖撕裂（IASRCTs）带来了重大挑战，尤其是在活动受限的年轻、活跃患者中，这些患者的关节保留选择有限。最近，Latissimus dorsi（LD）转移和Latissimus dorsi 与teres major（LDTM）联合转移已成为一种潜在的手术选择，引起了关注。我们旨在比较 LD 转移与 IASRCTs 中联合 LDTM 转移的临床和影像学结果。
在这项回顾性比较研究中，对 53 例 IASRCT 患者进行了分析，这些患者接受了 LD 转移附着于小转子（LT）（LD 组，n=23）或联合 LDTM 转移附着于大转子（GT）（LDTM 组，n=30）。临床评估包括疼痛的视觉模拟评分、主动肩部活动范围（ROM）、加州大学洛杉矶分校肩部评分、美国肩肘外科评分、需要主动内旋的日常生活活动（ADLIR）评分以及肩胛下肌（SSC）特定检查。影像学分析包括评估肩峰肱骨头距离（AHD）、Hamada 分级、前关节盂肱半脱位减少率以及转移肌腱的完整性。
两组患者术后疼痛和临床评分均有显著改善（<0.001）。在 2 年随访时，LDTM 组的内旋力量更强（<0.001），ADLIR 评分（=0.017）和 SSC 特定体格检查结果（仰卧起坐，=0.027；熊抱，=0.031；抬起，=0.032）。两组患者的 AHD 或 Hamada 分级均无明显变化。在最终随访时，两组之间的 AHD（=0.539）和 Hamada 分级（=0.974）无显著差异。尽管两组的术前前关节盂肱半脱位均得到改善，但 LDTM 组的恢复率明显高于 LD 组（=0.015）。
尽管 LD 和联合 LDTM 转移治疗 IASRCTs 均能改善术后疼痛缓解、临床评分和主动 ROM，但与 LD 转移附着于 LT 相比，联合 LDTM 转移附着于 GT 在内部旋转力量、ADLIR 评分和 SSC 特定检查方面更为优越。两组在 2 年随访时均未出现肩袖关节炎或 AHD 减少的显著进展；然而，联合 LDTM 转移明显改善了术前前关节盂肱半脱位。
