Aims Favourable short-term outcomes have been reported following latissimus dorsi tendon transfer for patients with an irreparable subscapularis (SSC) tendon tear. The aim of this study was to investigate the long-term outcomes of this transfer in these patients. Methods This was a retrospective study involving 30 patients with an irreparable SSC tear and those with a SSC tear combined with a reparable supraspinatus tear, who underwent a latissimus dorsi tendon transfer. Clinical scores and active range of motion (aROM), SSC-specific physical examination and the rate of return to work were assessed. Radiological assessment included recording the acromiohumeral distance (AHD), the Hamada grade of cuff tear arthropathy and the integrity of the transferred tendon. Statistical analysis compared preoperative, short-term (two years), and final follow-up at a mean of 8.7 years (7 to 10). Results There were significant improvements in clinical scores, in the range and strength of internal rotation and aROM compared with the preoperative values in the 26 patients (87%) who were available for long-term follow-up. These improvements were maintained between short- and long-term follow-ups. Although there was a decreased mean AHD of 7.3 mm (SD 1.5) and an increased mean Hamada grade of 1.7 (SD 0.5) at final follow-up, the rate of progression of cuff tear arthropathy remained low-grade. Comparison between the isolated SSC and combined SSC and reparable supraspinatus tear groups showed no significant differences. At final follow-up, one patient (3.8%) had undergone revision surgery to a reverse shoulder arthroplasty (RSA). No neurological complications were associated with the procedure. Conclusion Latissimus dorsi transfer for an irreparable SSC tendon tear resulted in a significant clinical improvement, particularly in pain, range and strength of internal rotation and aROM, which were maintained over a mean of 8.7 years following surgery. Given that this was a long-term outcome study, there was a low-grade progression in the rate of cuff tear arthropathy. Thus, the long-term clinical efficacy of latissimus dorsi tendon transfer in patients with irreparable SSC was confirmed as a joint-preserving procedure for these patients, suggesting it as an effective alternative to RSA in young, active patients without degenerative changes of the glenohumeral joint.

中文翻译：

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前背阔肌肌腱移植治疗不可修复的肩胛下肌撕裂的长期结果。


目标 对于不可修复的肩胛下肌 (SSC) 肌腱撕裂患者，背阔肌肌腱移植后已报告了良好的短期结果。本研究的目的是调查这些患者移植的长期结果。方法 这是一项回顾性研究，涉及 30 例不可修复的 SSC 撕裂和 SSC 撕裂合并可修复的冈上肌撕裂的患者，这些患者接受了背阔肌腱移植术。评估了临床评分和主动活动范围 (aROM)、SSC 特异性体检和重返工作岗位的比率。放射学评估包括记录肩肱距离（AHD）、袖带撕裂关节病的 Hamada 分级以及转移肌腱的完整性。统计分析比较了术前、短期（两年）和平均 8.7 年（7 至 10 年）的最终随访。结果 26例可长期随访的患者（87%）的临床评分、内旋范围和强度以及aROM与术前相比均有显着改善。这些改善在短期和长期随访期间得以维持。尽管最终随访时平均 AHD 降低了 7.3 mm (SD 1.5)，平均 Hamada 等级提高了 1.7 (SD 0.5)，但袖带撕裂关节病的进展率仍然较低。单独的SSC和组合的SSC以及可修复的冈上肌撕裂组之间的比较没有显示出显着差异。在最后一次随访时，一名患者 (3.8%) 接受了反向肩关节置换术 (RSA) 的翻修手术。没有与该手术相关的神经系统并发症。 结论 背阔肌移植治疗不可修复的 SSC 肌腱撕裂带来了显着的临床改善，特别是在疼痛、内旋范围和强度以及 aROM 方面，术后这些改善平均维持了 8.7 年。鉴于这是一项长期结果研究，袖带撕裂关节病的发生率呈低度进展。因此，背阔肌腱转移术对于不可修复的 SSC 患者的长期临床疗效被证实为这些患者的关节保留手术，表明对于年轻、活跃且没有盂肱关节退行性改变的患者来说，背阔肌腱移植术可以作为 RSA 的有效替代方案。