Background:Latissimus dorsi tendon transfer (LDTT) leads to good clinical outcomes and recovery of function. A previous study have evaluated the outcomes of LDTT at a minimum 10-year follow-up and found durable improvements in shoulder function and pain relief but observed that shoulders with fatty infiltration of the teres minor muscle and insufficiency of the subscapularis muscle tended to have inferior results.Purpose:To evaluate the outcomes of LDTT with a minimum follow-up of 10 years in a sizeable cohort for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs).Study Design:Case series; Level of evidence, 4.Methods:Patients who underwent LDTT for irreparable mRCTs between 2004 and 2013, performed by the same senior surgeon, were included in this study. All intraoperative and postoperative complications, as well as whether patients required conversion to reverse shoulder arthroplasty (RSA), were noted. At a minimum follow-up of 10 years, an independent observer collected range of motion measurements and clinical scores, including those for the Constant score, the Subjective Shoulder Value, and a visual analog scale for pain; the subacromial space was also assessed.Results:A total of 143 patients (147 shoulders) that underwent LDTT, with a minimum follow-up of 10 years, were included; of these, 24 patients (24 shoulders, 16%) were lost to follow-up, 1 patient (1 shoulder, 0.7%) died 9 years after the index procedure for reasons unrelated to shoulder surgery, and 18 patients (18 shoulders, 12%) required conversion to RSA, of which 6 underwent conversion at ≥6 years after LDTT. The remaining 101 patients (104 shoulders), including 3 patients who were scheduled to undergo RSA, were assessed at a mean time of 12.3 ± 2.2 years (range, 10-20 years) after index LDTT, comprised 52 men (53 shoulders) and 49 women (51 women) and had a mean age of 61.6 ± 8.0 years (range, 39-81 years) at the time of index surgery. Complications were noted in 14 shoulders, of which 4 required a reoperation. The Constant score improved by 34.2 ± 11.7 points, the adjusted Constant score by 43.5 ± 15.3 points, and the Subjective Shoulder Value score by 50.4 ± 16.4 points. The subacromial space decreased by 0.3 ± 2.0 mm.Conclusion:At a minimum follow-up of 10 years, LDTT for the treatment of irreparable posterosuperior mRCTs led to satisfactory clinical scores. Of the 147 shoulders that underwent LDTT, 18 (12%) required conversion to RSA.

中文翻译：

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背阔肌肌腱转移治疗无法修复的后上大块肩袖撕裂后令人满意的临床结果：10 至 20 年的随访


背景： 背阔肌腱转移术 （LDTT） 导致良好的临床结局和功能恢复。之前的一项研究在至少 10 年的随访中评估了 LDTT 的结果，发现肩部功能和疼痛缓解有持久的改善，但观察到圆肌小肌脂肪浸润和肩胛下肌功能不全的肩部往往效果较差。目的： 评估 LDTT 在大型队列中至少随访 10 年治疗无法修复的后上大块肩袖撕裂 （mRCT） 的结局。研究设计： 病例系列;证据水平， 4.方法： 2004 和 2013年接受 LDTT 治疗无法修复的 mRCTs 的患者，由同一位高级外科医生进行，被纳入本研究。记录所有术中和术后并发症，以及患者是否需要转为反向肩关节置换术 （RSA）。在至少 10 年的随访中，一名独立观察者收集了运动测量范围和临床评分，包括常数评分、主观肩值和疼痛视觉模拟量表;还评估了肩峰下间隙。结果： 共纳入 143 例接受 LDTT 的患者 （147 例肩关节），至少随访 10 年;其中，24 例患者 （24 例肩关节，16%） 失访，1 例患者 （1 例肩关节，0.7%） 在指数手术后 9 年因与肩关节手术无关的原因死亡，18 例患者 （18 例肩关节，12%） 需要转为 RSA，其中 6 例在 LDTT 后 ≥ 6 年发生转修。其余 101 名患者 （104 名肩部），包括 3 名计划接受 RSA 的患者，平均评估时间为 12.3 ± 2。指数 LDTT 后 2 年 （范围，10-20 岁），包括 52 名男性 （53 名肩部） 和 49 名女性 （51 名女性），指数手术时的平均年龄为 61.6 ± 8.0 岁 （范围，39-81 岁）。14 个肩膀出现并发症，其中 4 个需要再次手术。常数评分提高了 34.2 分± 11.7 分，调整后的常数评分提高了 43.5 ± 15.3 分，主观肩值评分提高了 50.4 ± 16.4 分。肩峰下间隙减小了 0.3 ± 2.0 mm.结论： 至少随访 10 年，LDTT 治疗无法修复的后上 mRCTs 导致令人满意的临床评分。在接受 LDTT 的 147 个肩膀中，18 个（12%）需要转换为 RSA。