Advance of massive tear of the rotator cuff treated with a deltoid flap / 中华骨科杂志

ABSTRACT

Massive rotator cuff tears often destroy equilibrium of couples of the shoulder joints,whichlead toshoulder pain and functional incapacitation.At present,there is a great controversy about the best treatment strategy for the massive rotator cuff tear,nevertheless surgery has been proved to have more satisfactory results than non-operative treatment.It has been confirmed by numerous studies that cuff repair could prevent loss of shoulder strength and glenohumeral osteoarthritis.However,it is impossible to suture tendon to bone directly due to retraction of tendon stump,fat infiltration of rotator cuff and prominent tear size in massive rotator cuff tear.Muscular flap transfer procedures have played important roles in the treatment of massive rotator cuff tears.Compared with other tendon transposition procedures,such as latissimus dorsi transfer,the deltoid muscular flap may be an optimal method as it works synergistically with the infraspinatus and supraspinatus muscle,and presses down the humeral head potentially.Cuff repair in open operation with tendon stump re-attachment to the deltoid muscle flap,aims to reconstruct the cuff continuity and cover the humeral head toform a new cuff.The deltoid muscle flap,also acting as a muscle cushion,is expected to reduce impingement between the humeral head and the acromion and get better results of pain relief and improvement of shoulder function.However,it is still controversial about the efficacy of deltoid muscle flap transfer in reconstructing a new balance of couple with better shoulder strength,alleviating glenohumeral arthritis and preventing tendon retears.This article reviews the advances in the treatment of chronic massive rotator cuff tears with deltoid flap transfer.