Kim Bo Taek, Miranda Luis Alfredo, Kim Jung Gon, Lim Chaemoon, Baek Gyuna, Werthel Jean-David, Baek Chang Hee, Kany Jean
Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea.
Department of Orthopaedic Surgery, Hospital Cima Hermosillo, Sonora, México.
J Shoulder Elbow Surg. 2025 Apr 26. doi: 10.1016/j.jse.2025.03.023.
Posterior-superior irreparable rotator cuff tears (PSIRCTs) are a significant challenge in managing active individuals without arthritis traditional latissimus dorsi (LD) transfer is prone to retear due to the tendon's thinness and yields suboptimal outcomes with subscapularis tears. This study evaluates the clinical outcomes of fully arthroscopic combined LD and teres major transfer in patients with PSIRCTs without arthritis.
This retrospective study included patients who underwent fully arthroscopic LD teres major (LDTM) transfer for PSIRCTs from January 2018 to February 2022. Inclusion criteria included persistent with irreparable supraspinatus and infraspinatus tears and minimal glenohumeral arthritis. Excluded were patients who were lost to follow-up or had less than 2 years of follow-up. Clinical outcomes were assessed using visual analog scale, Simple Shoulder Test, Subjective Shoulder Value, American Shoulder and Elbow Surgeons score, Activities of Daily Living requiring active External Rotation score, and range of motion. Progression of arthritis was evaluated, and any complications were recorded.
A total of 90 patients were included, with a mean age of 64.6 years and an average follow-up period of 36.6 months. Significant improvements were observed in visual analog scale and all patient-reported outcome measures, with P < .001. Significant improvements were observed in forward elevation (124°-153°), abduction (88°-137°), external rotation at the side (17°-34°), and external rotation at 90° abduction (45°-52°). Three patients experienced progression of arthritis, leading to conversion to reverse total shoulder arthroplasty. No retear of transferred LDTM were found. Four cases of axillary nerve palsy were reported, with 2 being transient.
The fully arthroscopic LDTM transfer provides significant pain relief and functional improvements in managing PSIRCTs. There was significant improvement in all patient-reported outcome measures and shoulder range of motion. Three patients developed progression of arthritis, leading to conversion to reverse total shoulder arthroplasty.
后上不可修复性肩袖撕裂（PSIRCTs）对于治疗无关节炎的活跃个体而言是一项重大挑战。传统的背阔肌（LD）转移术由于肌腱较薄，容易再次撕裂，并且在合并肩胛下肌撕裂时效果欠佳。本研究评估了在无关节炎的PSIRCTs患者中，完全关节镜下联合背阔肌和大圆肌转移术的临床疗效。
这项回顾性研究纳入了2018年1月至2022年2月期间因PSIRCTs接受完全关节镜下背阔肌-大圆肌（LDTM）转移术的患者。纳入标准包括持续性不可修复的冈上肌和冈下肌撕裂以及轻度的盂肱关节炎。排除失访或随访时间不足2年的患者。使用视觉模拟评分、简易肩关节测试、主观肩关节评分、美国肩肘外科医师评分、需要主动外旋的日常生活活动评分以及活动范围来评估临床疗效。评估关节炎的进展情况，并记录任何并发症。
共纳入90例患者，平均年龄64.6岁，平均随访期36.6个月。视觉模拟评分以及所有患者报告的结局指标均有显著改善，P < 0.001。前屈上举（从124°至153°）、外展（从88°至137°）、体侧外旋（从17°至34°）以及90°外展位外旋（从45°至52°）均有显著改善。3例患者出现关节炎进展，导致改行反式全肩关节置换术。未发现转移的LDTM再次撕裂。报告了4例腋神经麻痹，其中2例为短暂性。
完全关节镜下LDTM转移术在治疗PSIRCTs方面能显著缓解疼痛并改善功能。所有患者报告的结局指标以及肩关节活动范围均有显著改善。3例患者出现关节炎进展，导致改行反式全肩关节置换术。
