Warnhoff Mara, Moroder Philipp, Audigé Laurent, Spagna Giovanni, Ameziane Yacine, Schneller Tim, Scheibel Markus, Freislederer Florian
Schulthess Clinic, 8008 Zurich, Switzerland.
Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany.
J Clin Med. 2025 Aug 11;14(16):5679. doi: 10.3390/jcm14165679.
: The management of irreparable posterosuperior rotator cuff tears with an isolated loss of external rotation presents significant challenges. Latissimus dorsi tendon transfer in conjunction with medialized reverse total shoulder arthroplasty has been employed to rectify external rotation deficits; however, lateralized RTSA designs may yield similar outcomes with a reduced incidence of complications. The objective of this study was to compare the clinical outcomes of lateralized reverse total shoulder arthroplasty without latissimus dorsi tendon transfer against medialized RTSA with LDT in patients with ILER and a positive external rotation lag sign. : This retrospective cohort study involved 34 patients diagnosed with CTA and severe external rotation deficiency, characterized by a positive ER lag sign and 0° active ER. The patients were treated with either lateralized reverse total shoulder arthroplasty ( = 21) or medialized RTSA with LDT ( = 13). Outcomes evaluated preoperatively and at the 24-month follow-up comprised range of motion, ER lag sign, Constant-Murley Score, SPADI, and radiographic offset parameters. Statistical analyses were adjusted for age, sex, and baseline values. : At follow-up, 70% of patients undergoing lateralized RTSA exhibited resolution of ER lag, compared to 23% in the LDT group ( < 0.05). Active external rotation improvement was more significant in the LDT group (34.6° compared to 18.5°, < 0.05). However, both groups exhibited comparable final external rotation and functional scores (CMS: 63 ± 9 vs. 63 ± 16; SPADI: 73 ± 20 vs. 74 ± 22). Lateralized RTSA demonstrated superior preservation of internal rotation, as evidenced by a higher percentage of patients achieving a negative Apley scratch test (67% compared to 23%, < 0.05). A greater glenoidal offset correlated with improved postoperative external rotation and resolution of external rotation lag. The influence of teres minor integrity was more significant in the LDT group. : Lateralized reverse total shoulder arthroplasty without latissimus dorsi tendon transfer provides similar functional restoration of external rotation in irreparable posterosuperior rotator cuff tear patients, accompanied by reduced complications, shorter surgical durations, and improved preservation of internal rotation. LDT has the potential to provide enhanced ER gains from a low baseline; however, it is characterized by increased invasiveness and technical complexity. Prosthetic lateralization is a biomechanically effective method for restoring external rotation in patients with rotator cuff arthropathy and external rotation deficits.
对于存在外旋孤立性丧失的不可修复的后上肩袖撕裂的治疗提出了重大挑战。背阔肌肌腱转移联合内移式反向全肩关节置换术已被用于纠正外旋缺陷；然而，外移式反向全肩关节置换术（RTSA）设计可能产生相似的结果且并发症发生率更低。本研究的目的是比较在患有不可修复的后上肩袖撕裂（ILER）且外旋滞后征阳性的患者中，不进行背阔肌肌腱转移的外移式反向全肩关节置换术与进行背阔肌肌腱转移的内移式RTSA的临床结果。：这项回顾性队列研究纳入了34例被诊断为慢性肩袖撕裂关节炎（CTA）且存在严重外旋缺陷的患者，其特征为外旋滞后征阳性且主动外旋为0°。这些患者接受了外移式反向全肩关节置换术（n = 21）或进行背阔肌肌腱转移的内移式RTSA（n = 13）治疗。术前及24个月随访时评估的结果包括活动范围、外旋滞后征、Constant - Murley评分、SPADI以及影像学偏移参数。统计分析对年龄、性别和基线值进行了校正。：在随访时，接受外移式RTSA的患者中有70%的外旋滞后征消失，而背阔肌肌腱转移组为23%（P < 0.05）。背阔肌肌腱转移组的主动外旋改善更显著（分别为34.6°和18.5°，P < 0.05）。然而，两组的最终外旋和功能评分相当（CMS：63 ± 9 对比 63 ± 16；SPADI：73 ± 20 对比 74 ± 22）。外移式RTSA显示出更好的内旋保留，这通过更多患者阿普利刮痕试验结果为阴性得到证明（分别为67%和23%，P < 0.05）。更大的关节盂偏移与术后外旋改善和外旋滞后征消失相关。在背阔肌肌腱转移组中，小圆肌完整性的影响更显著。：不进行背阔肌肌腱转移的外移式反向全肩关节置换术在不可修复的后上肩袖撕裂患者中能提供相似的外旋功能恢复，同时并发症减少、手术时间缩短且内旋保留改善。背阔肌肌腱转移有可能从低基线提供更大的外旋改善；然而，其特点是侵袭性增加和技术复杂性提高。假体外移是在肩袖关节病和外旋缺陷患者中恢复外旋的一种生物力学有效方法。
