Baek Chang Hee, Lim Chaemoon, Kim Jung Gon, Kim Bo Taek, Kim Seung Jin
Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea.
Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea.
J Shoulder Elbow Surg. 2025 Feb 27. doi: 10.1016/j.jse.2025.01.034.
This retrospective study aimed to compare the clinical results of reverse total shoulder arthroplasty (rTSA) and combined anterior latissimus dorsi and teres major (aLDTM) tendon transfer in patients with nonarthritic anterosuperior irreparable rotator cuff tears (ASIRCTs) with loss of active internal rotation (aIR).
Using propensity score matching based on demographic variables, 29 patients were included in each group (rTSA and aLDTM) with a minimum follow-up period of 2 years. Clinical results were evaluated using the visual analog scale score, Constant-Murley score, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, activities of daily living requiring active internal rotation, active range of motion, subscapularis-specific examinations, rotational strength, and the ability to perform toileting activities. The progression of arthritic changes in the shoulder joint was evaluated by the acromiohumeral distance and Hamada grade.
Significant improvements of clinical results were confirmed in both groups. However, the Constant-Murley score (58.4 ± 10.5 vs. 69.1 ± 8.2, P < .001), American Shoulder and Elbow Surgeons score (64.5 ± 12.3 vs. 78.5 ± 10.9, P < .001), University of California Los Angeles shoulder score (22.9 ± 5.3 vs. 28.2 ± 4.1, P < .001), forward elevation (134.1 ± 35.7 vs. 162.4 ± 15.5, P < .001), and internal rotation (IR) at the back (4.6 ± 1.1 vs. 6.9 ± 2.2, P < .001) were significantly better in the aLDTM group compared with the rTSA group. The subscapularis-specific physical examination (P < .001), IR strength (P < .001), and the ability to perform toileting activities (P < .001) were significantly better in the aLDTM group compared with the rTSA group. There was no significant change in the acromiohumeral distance (preoperative 8.3 ± 1.3 to postoperative 8.5 ± 1.8, P = .367) and no significant progression of arthritic change (Hamada grade preoperative 1.4 ± 0.5 to postoperative 1.5 ± 0.6, P = .458) in the aLDTM group.
Both rTSA and aLDTM improved overall patient outcomes postoperatively. However, combined aLDTM tendon transfer was superior in terms of clinical scores, IR active range of motion, IR strength, and the ability to perform toileting activities in patients with ASIRCTs and loss of aIR. This study suggests that combined aLDTM tendon transfer could be a first-line joint-saving treatment for patients with nonarthritic ASIRCTs and loss of aIR, considering the longevity and related complications of arthroplasty.
本回顾性研究旨在比较反向全肩关节置换术（rTSA）与背阔肌和大圆肌联合（aLDTM）肌腱转移术治疗非关节炎性前上不可修复性肩袖撕裂（ASIRCT）伴主动内旋（aIR）丧失患者的临床结果。
基于人口统计学变量进行倾向得分匹配，每组纳入29例患者（rTSA组和aLDTM组），随访期至少2年。使用视觉模拟量表评分、Constant-Murley评分、美国肩肘外科医师评分、加利福尼亚大学洛杉矶分校肩关节评分、需要主动内旋的日常生活活动、主动活动范围、肩胛下肌特异性检查、旋转力量以及进行如厕活动的能力来评估临床结果。通过肩峰下间隙距离和滨田分级评估肩关节关节炎变化的进展。
两组的临床结果均有显著改善。然而，与rTSA组相比，aLDTM组的Constant-Murley评分（58.4±10.5对69.1±8.2，P<.001）、美国肩肘外科医师评分（64.5±12.3对78.5±10.9，P<.001）、加利福尼亚大学洛杉矶分校肩关节评分（22.9±5.3对28.2±4.1，P<.001）、前屈（134.1±35.7对162.4±15.5，P<.001）以及背部内旋（IR）（4.6±1.1对6.9±2.2，P<.001）明显更好。与rTSA组相比，aLDTM组的肩胛下肌特异性体格检查（P<.001）、IR力量（P<.001）以及进行如厕活动的能力（P<.001）明显更好。aLDTM组的肩峰下间隙距离无显著变化（术前8.3±1.3至术后8.5±1.8，P=.367），且关节炎变化无显著进展（滨田分级术前1.4±0.5至术后1.5±0.6，P=.458）。
rTSA和aLDTM术后均改善了患者的总体预后。然而，对于ASIRCT伴aIR丧失的患者，aLDTM肌腱转移术在临床评分、IR主动活动范围、IR力量以及进行如厕活动的能力方面更具优势。考虑到关节置换术的长期效果和相关并发症，本研究表明aLDTM肌腱转移术可能是治疗非关节炎性ASIRCT伴aIR丧失患者的一线保关节治疗方法。
