Baek Chang Hee, Kim Bo Taek, Kim Jung Gon, Kim Seung Jin
Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea.
Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea.
J Shoulder Elbow Surg. 2025 Jul;34(7):e524-e531. doi: 10.1016/j.jse.2024.09.042. Epub 2024 Nov 30.
Lower trapezius tendon (LTT) transfer has emerged as a promising surgical intervention for addressing posterosuperior irreparable rotator cuff tears (PSIRCTs) in the absence of glenohumeral arthritis. However, comparative studies evaluating primary vs. secondary LTT transfers following rotator cuff repair failure are limited.
This retrospective study analyzed 103 patients who underwent LTT transfer for PSIRCTs without glenohumeral arthritis. Patients were categorized into Group Primary (no prior shoulder surgeries, n = 83) and Group Secondary (previous rotator cuff repairs failure, n = 20). Clinical outcomes were assessed using the visual analog scale (VAS), Constant score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, University of California-Los Angeles (UCLA) score, and Single Assessment Numeric Evaluation (SANE) score. Radiologic evaluations included acromiohumeral distance (AHD) and Hamada classification. Incidences of complications such as retears and infections were documented.
The mean age for the Group Primary and the Group Secondary was 63.3 ± 6.3 years and 61.5 ± 4.8 years, respectively, with mean follow-up periods of 37.4 ± 15.7 months and 42.9 ± 16.8 months, respectively. Both Group Primary and Group Secondary demonstrated significant postoperative improvements in VAS, Constant, ASES, UCLA, and SANE scores, with no statistically significant differences observed between the groups. Radiologically, both groups showed a slight progression of glenohumeral arthritis with no significant differences between the groups. Retears of transferred tendon occurred at a similar rate in each group, with 18% in Group Primary and 20% in the Group Secondary.
Secondary LTT transfer following rotator cuff repair failure represents an effective surgical approach for managing PSIRCTs, demonstrating comparable improvements in clinical and radiologic outcomes to primary LTT transfer. These findings support the consideration of LTT transfer irrespective of prior rotator cuff repair history. Long-term follow-up studies are essential to evaluate the durability and functional outcomes over extended periods.
在不存在盂肱关节炎的情况下，下斜方肌腱（LTT）转移已成为一种有前景的手术干预方法，用于治疗后上不可修复的肩袖撕裂（PSIRCTs）。然而，评估肩袖修复失败后一期与二期LTT转移的对比研究有限。
这项回顾性研究分析了103例因PSIRCTs且无盂肱关节炎而接受LTT转移的患者。患者被分为一期组（无既往肩部手术史，n = 83）和二期组（既往肩袖修复失败，n = 20）。使用视觉模拟量表（VAS）、Constant评分、美国肩肘外科医师协会标准化肩部评估表（ASES）评分、加利福尼亚大学洛杉矶分校（UCLA）评分和单一评估数字评价（SANE）评分评估临床结果。放射学评估包括肩峰下间隙（AHD）和滨田分类。记录再撕裂和感染等并发症的发生率。
一期组和二期组的平均年龄分别为63.3±6.3岁和61.5±4.8岁，平均随访期分别为37.4±15.7个月和42.9±16.8个月。一期组和二期组术后VAS、Constant、ASES、UCLA和SANE评分均有显著改善，两组间无统计学显著差异。放射学上，两组均显示盂肱关节炎有轻微进展，组间无显著差异。每组中转移肌腱的再撕裂发生率相似，一期组为18%，二期组为20%。
肩袖修复失败后二期LTT转移是治疗PSIRCTs的一种有效手术方法，在临床和放射学结果方面显示出与一期LTT转移相当的改善。这些发现支持无论既往肩袖修复史如何，都可考虑进行LTT转移。长期随访研究对于评估长期的耐久性和功能结果至关重要。
