Bobko Aimee, Uppstrom Tyler J, Jahandar Amirhossein, Cecere Robert, Nicholson Allen D, Kontaxis Andreas, Gulotta Lawrence V, Dines David M, Warren Russell F, Fu Michael C, Taylor Samuel A, Blaine Theodore A
Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA.
Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA.
J Shoulder Elbow Surg. 2025 Jul;34(7):1641-1649. doi: 10.1016/j.jse.2024.10.020. Epub 2024 Dec 24.
Patients undergoing reverse total shoulder arthroplasty (rTSA) for rotator cuff arthropathy may present with an external rotation (ER) lag due to posterior rotator cuff insufficiency. As a result, the addition of a latissimus dorsi (LD) tendon transfer in combination with rTSA has become increasingly utilized. Initial descriptions of LD tendon transfer involved rerouting of the LD tendon posterior to the long head of the triceps tendon. However, more recent techniques involve rerouting the LD tendon anterior to the long head of the triceps tendon via the deltopectoral approach utilized for rTSA. The purpose of this cadaveric study was to assess the biomechanical effect on ER force of LD tendon transfer anterior vs. posterior to the long head of the triceps tendon in combination with rTSA.
Eight fresh frozen cadaveric shoulders were utilized. A shoulder fellowship trained orthopedic surgeon performed rTSA in each specimen. The rotator cuff tendon attachments were cut to simulate a massive rotator cuff tear. The LD tendon was transferred to the greater tuberosity first anterior to the long head of the triceps, and then posterior to the long head of the triceps. The specimens underwent biomechanical testing for each condition using an established cadaveric shoulder simulator with 6 degrees of freedom for glenohumeral joint motion.
Both anterior and posterior LD tendon transfers successfully achieved ER of the humerus when force was applied to the LD tendon. Posterior LD tendon transfer resulted in less required force to achieve ER of the arm throughout range of motion compared to anterior LD tendon transfer (33.4 N vs. 48.6 N, P < .001), which was maintained irrespective of glenohumeral abduction angle. Loading of the long head of the triceps tendon was associated with significantly increased force required for generation of ER only in the anterior LD tendon transfer condition (48.6 N loaded vs. 39.4 N unloaded; P < .001).
LD tendon transfer posterior to the long head of the triceps resulted in more efficient humeral ER movements in the setting of rTSA, irrespective of degree of shoulder abduction. Our results also demonstrate that long head of the triceps tension results in decreased efficiency of the LD tendon transfer when performed anterior to the long head of the triceps. While technically more difficult, transfer of the LD tendon posterior to the long head of the triceps provides a mechanical advantage that may improve clinical outcomes in patients with rTSA lacking ER.
因肩袖关节病接受反式全肩关节置换术（rTSA）的患者，可能由于后方肩袖功能不全而出现外旋（ER）滞后。因此，背阔肌（LD）肌腱转移联合rTSA的应用越来越广泛。最初对LD肌腱转移的描述是将LD肌腱重新路由到肱三头肌腱长头后方。然而，最近的技术是通过用于rTSA的三角肌胸大肌入路，将LD肌腱重新路由到肱三头肌腱长头前方。本尸体研究的目的是评估在联合rTSA时，LD肌腱转移至肱三头肌腱长头前方与后方对ER力的生物力学影响。
使用8个新鲜冷冻的尸体肩关节。一位接受过肩关节专科培训的骨科医生在每个标本上进行rTSA。切断肩袖肌腱附着点以模拟巨大的肩袖撕裂。首先将LD肌腱转移至肱三头肌腱长头前方的大结节，然后转移至肱三头肌腱长头后方。使用具有6个自由度的成熟尸体肩关节模拟器，对每种情况的标本进行生物力学测试，以进行盂肱关节运动。
当对LD肌腱施加力时，LD肌腱前后转移均成功实现了肱骨的外旋。与LD肌腱前转位相比，LD肌腱后转位在整个运动范围内实现手臂外旋所需的力更小（33.4 N对48.6 N，P <.001），且无论盂肱关节外展角度如何均保持这一差异。仅在LD肌腱前转位情况下，肱三头肌腱长头加载与产生外旋所需的力显著增加相关（加载时48.6 N对未加载时39.4 N；P <.001）。
在rTSA的情况下，将LD肌腱转移至肱三头肌腱长头后方可使肱骨外旋运动更有效，无论肩关节外展程度如何。我们的结果还表明，当在肱三头肌腱长头前方进行LD肌腱转移时，肱三头肌腱长头的张力会导致LD肌腱转移效率降低。虽然技术上更困难，但将LD肌腱转移至肱三头肌腱长头后方可提供机械优势，可能改善缺乏外旋功能的rTSA患者的临床结果。
