Isolated Latissimus Dorsi Transfer versus Combined Latissimus Dorsi and Teres Major Tendon Transfer for Irreparable Anterosuperior Rotator Cuff Tears.

Autor:	Baek CH; Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Korea., Kim JG; Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Korea., Kim BT; Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Korea., Kim SJ; Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Korea.
Jazyk:	angličtina
Zdroj:	Clinics in orthopedic surgery [Clin Orthop Surg] 2024 Oct; Vol. 16 (5), pp. 761-773. Date of Electronic Publication: 2024 Sep 13.
DOI:	10.4055/cios24115
Abstrakt:	Background: Irreparable anterosuperior rotator cuff tears (IASRCTs) present significant challenges, especially in young, active patients with limited joint-preserving options. Recently, latissimus dorsi (LD) transfer and combined latissimus dorsi and teres major (LDTM) transfer have gained attention as a potential surgical option. We aimed to compare the clinical and radiological outcomes of LD versus combined LDTM transfer in IASRCTs. Methods: In this retrospective comparative study, 53 patients with IASRCTs were analyzed after undergoing either LD transfer attached to lesser tuberosity (LT) (LD group, n = 23) or combined LDTM transfer attached to greater tuberosity (GT) (LDTM group, n = 30). Clinical evaluations included the visual analog scale score for pain, active shoulder range of motion (ROM), University of California Los Angeles Shoulder Score, American Shoulder and Elbow Surgeons score, activities of daily living that require active internal rotation (ADLIR) scores, and subscapularis (SSC)-specific examinations. Radiographic analyses involved assessing acromiohumeral distance (AHD), Hamada grade, the rate of anterior glenohumeral subluxation reduction, and integrity of the transferred tendon. Results: Postoperatively, both groups demonstrated significant improvements in pain and clinical scores ( p < 0.001). At the 2-year follow-up, the LDTM group showed superior internal rotation strength ( p < 0.001), ADLIR score ( p = 0.017), and SSC-specific physical examination results (belly-press, p = 0.027; bear-hug, p = 0.031; lift-off, p = 0.032). No significant changes in AHD or Hamada grade were observed in either group. At final follow-up, no significant differences were found between the 2 groups in terms of AHD ( p = 0.539) and Hamada grade ( p = 0.974). Although preoperative anterior glenohumeral subluxation was improved in both groups, the LDTM group showed a statistically significantly higher rate of restoration compared to the LD group ( p = 0.015). Conclusions: While both LD and combined LDTM transfers for IASRCTs improved postoperative pain relief, clinical scores, and active ROM, the combined LDTM transfer attached to GT was superior to LD transfer attached to LT in terms of internal rotational strength, ADLIR score, and SSC-specific examinations. Neither group showed significant progress in cuff tear arthropathy or decreased AHD at 2-year follow-up; however, the combined LDTM transfer notably improved preoperative anterior glenohumeral subluxation. Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported. (Copyright © 2024 by The Korean Orthopaedic Association.)
Databáze:	MEDLINE
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