Hussain Zaamin B, McKissack Haley M, Gulzar Musab, Cooke Hayden L, Khawaja Sameer R, Chopra Krishna N, Gottschalk Michael B, Wagner Eric R
From the Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA.
J Am Acad Orthop Surg. 2025 Apr 23;33(14):e795-e806. doi: 10.5435/JAAOS-D-24-01307.
Arthroscopic lower trapezius tendon transfer (aLTT) is an effective strategy to treat massive rotator cuff tears by dynamically restoring the posterior aspect of the rotator cuff force couple and improving range of motion, strength, pain, and stability. aLTT is technically challenging with higher complication rates, and its learning curve has yet to be defined. We aimed to establish a learning curve for aLTT through trends in surgical time, postoperative outcomes, and complications. We hypothesized that increased surgeon experience would be associated with decreased surgical time, improved outcomes, and reduced complication rates.
All patients who underwent primary aLTT at our institution between October 2018 and November 2022 were identified and included. Perioperative data, including diagnosis, operative time, complications, revisions, postoperative functional data, and patient-reported outcomes, were recorded and analyzed. A shoulder and elbow fellowship-trained surgeon's learning curve was determined using linear regression and cumulative sum (CUSUM) analyses. The CUSUM analysis evaluated objective differences in surgical time over the surgeon's course of practice and elucidated the completion of the learning curve.
Thirty-nine patients were included, with an average follow-up of 29 months. Mean surgical time was 163 minutes, with a linear decrease in surgical time throughout the study. CUSUM analysis of surgical times demonstrated a learning curve of 14 patients. When comparing the first 14 patients to the remaining 25, no difference was found in range of motion, American Shoulder and Elbow Surgeon score, and subjective shoulder value score, whereas visual analog scale pain scores at the final follow-up decreased in the proficiency phase.
This study found a notable linear decrease in surgical time and the number of cases completed without associated detriment to postoperative outcomes. At least 14 cases were required to exit the "learning phase." Further work is needed to find superior metrics to assess proficiency.
4, case series.
关节镜下下斜方肌腱转移术（aLTT）是治疗巨大肩袖撕裂的一种有效策略，可通过动态恢复肩袖力偶的后部并改善活动范围、力量、疼痛和稳定性。aLTT在技术上具有挑战性，并发症发生率较高，其学习曲线尚未明确。我们旨在通过手术时间、术后结果和并发症的趋势来建立aLTT的学习曲线。我们假设外科医生经验的增加将与手术时间的减少、结果的改善和并发症发生率的降低相关。
确定并纳入了2018年10月至2022年11月期间在我们机构接受初次aLTT的所有患者。记录并分析围手术期数据，包括诊断、手术时间、并发症、翻修、术后功能数据和患者报告的结果。使用线性回归和累积和（CUSUM）分析确定接受过肩肘专科培训的外科医生的学习曲线。CUSUM分析评估了外科医生在其执业过程中手术时间的客观差异，并阐明了学习曲线的完成情况。
纳入39例患者，平均随访29个月。平均手术时间为163分钟，在整个研究过程中手术时间呈线性下降。手术时间的CUSUM分析显示学习曲线为14例患者。将前14例患者与其余25例患者进行比较，在活动范围、美国肩肘外科医生评分和主观肩关节价值评分方面未发现差异，而在熟练阶段，末次随访时视觉模拟量表疼痛评分有所下降。
本研究发现手术时间和完成的病例数显著线性下降，且对术后结果无相关不利影响。至少需要14例病例才能走出“学习阶段”。需要进一步开展工作以找到评估熟练程度的更优指标。
4，病例系列。
