Arthroscopic lattisimus dorsi transfer with rotator cuff repair for posterosuperior irreparable massive rotator cuff tear / 中华骨科杂志

ABSTRACT

Objective To discuss the effect of arthroscopic latissimus dorsi transfer with rotator cuff repair for posterosuperior irreparable massive rotator cuff tear (iMRCT).Methods From September 2014 to December 2015,data of 13 iMRCT including 4 male and 9 female who underwent arthroscopic latissimus dorsi transfer with rotator cuff repair were retrospectively analyzed.The age was ranged from 54 to 65,with a mean age of 58.5±4.3.The mean duration of symptom was 2.1±0.6 years.During operation,complete or partial rotator cuff repair was performed,followed by complete repair of injured subscapularis tendon and tenotomy or tenodesis of the long head of biceps tendon.An arc incision was then made in the axillary fossa to harvest latissimus dorsi tendon from its humeral insertion.The tendon was then introduced into subacromial space and fixed at the footprint of greater tuberosity arthroscopically.X-ray and MRI were conducted prior to and one day after the surgery and at the last follow-up.Pain visual analog scale (VAS) and active range of motion in all planes as well as Constant-Murley score and Fudan University shoulder score (FUSS) were documented before the surgery and at the last follow-up.Results All 13 patients accomplished the follow-up,with a duration from 17 to 22 months and a mean period of 19.6±0.9 months.No complications occurred.No re-tear was identified.The mean acromiohumeral distance increased from 5.4± 1.1 mm to 7.0±0.6 mm.The mean VAS decreased from 4.8± 1.3 to 0.5± 0.7.The mean 0° abduction external rotation,90° abduction external rotation,flexion,as well as abduction increased from 17.3°± 10.5°,12.4°±7.8°,89.2°±41.2°,87.3°±40.7° to 41.2°±12.5°,56.5°±16.6°,120.5°±25.1°,and 113.5°±25.4° respectively.Constant-Mur ley score and FUSS increased from 33.5±9.9 and 50.9±7.6 to 62.8±8.1,and 81.7±7.0,respectively.The improvement in all measurements was significant.Condclion For posterosuperior iMRCT,arthroscopic latissimus dorsi transfer with rotator cuff repair can decrease shoulder pain and improve shoulder function.