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.
J Orthop. 2025 Jan 17;69:10-17. doi: 10.1016/j.jor.2025.01.013. eCollection 2025 Nov.
Latissimus dorsi transfer (LDT) is a well-known tendon-transfer technique with long-term clinical follow-up results, whereas superior capsular reconstruction (SCR) has recently emerged as a treatment option for posterosuperior irreparable rotator cuff tears (PSIRCTs). However, only a few small short-term comparative studies have evaluated SCR and LDT. We evaluated the clinical and radiological outcomes of SCR and LDT in PSIRCTs without arthritic changes.
This retrospective clinical comparative study evaluated patients who underwent SCR or LDT for PSIRCTs and had a mid-term (at least 5 years) follow-up. 28 patients in the SCR group and 31 in the LDT group were included. The visual analog scale (VAS) score, patient-reported clinical outcome scores, and active range of motion (aROM) were used for assessing clinical outcomes. The radiologic outcomes including progression of glenohumeral osteoarthritis and graft integrity were evaluated using Hamada grade and Sugaya classification, respectively.
Significant improvements in VAS scores and aROM were observed in both groups. The LDT group reported significant improvements in all patient-reported outcome scores. However, SCR group showed no significant improvement in patient-reported outcome scores except for American Shoulder and Elbow Surgeons score. In radiologic outcomes, AHD was significantly decreased, and the Hamada grade was significantly increased postoperatively in both groups. Moreover, the progression of arthritic change was significantly greater in the LDT group, while the rate of graft retear was markedly higher in the SCR group.
Although both SCR and LDT improved clinical outcomes, LDT was superior to SCR in terms of patient-reported outcome scores. However, progression of osteoarthritis is more common in LDT whereas graft retear is more common in SCR. Therefore, SCR or LDT could be considered as a surgical treatment in PSIRCTs without arthritic changes, but clinical outcomes as well as complications (osteoarthritis and graft re-tear) must be considered.
Level of evidence, III.
背阔肌转移术（LDT）是一种广为人知的肌腱转移技术，有着长期的临床随访结果，而上盂唇重建术（SCR）最近已成为治疗后上不可修复性肩袖撕裂（PSIRCT）的一种选择。然而，仅有少数小型短期比较研究对SCR和LDT进行了评估。我们评估了无关节炎改变的PSIRCT患者接受SCR和LDT后的临床及影像学结果。
这项回顾性临床比较研究评估了因PSIRCT接受SCR或LDT且进行了中期（至少5年）随访的患者。SCR组纳入28例患者，LDT组纳入31例患者。采用视觉模拟量表（VAS）评分、患者报告的临床结局评分以及主动活动范围（aROM）来评估临床结果。分别使用滨田分级和菅谷分类评估包括盂肱关节炎进展和移植物完整性在内的影像学结果。
两组的VAS评分和aROM均有显著改善。LDT组在所有患者报告的结局评分上均有显著改善。然而，SCR组除美国肩肘外科医师学会评分外，患者报告的结局评分无显著改善。在影像学结果方面，两组术后平均肱骨头下移（AHD）均显著降低，滨田分级均显著升高。此外，LDT组关节炎改变的进展明显更大，而SCR组移植物再撕裂率明显更高。
虽然SCR和LDT均改善了临床结果，但在患者报告的结局评分方面，LDT优于SCR。然而，骨关节炎进展在LDT中更常见，而移植物再撕裂在SCR中更常见。因此，对于无关节炎改变的PSIRCT，SCR或LDT可被视为一种手术治疗方法，但必须考虑临床结果以及并发症（骨关节炎和移植物再撕裂）。
证据水平，III级。
