Editorial Commentary: Arthroscopic Lower Trapezius Tendon Transfer Using Achilles Tendon Allograft for Isolated, Irreparable Infraspinatus Musculotendinous Tear Is Durable.

IF 4.4 1区 医学 Q1 ORTHOPEDICS
Ayham Jaber, Christopher J Hawryluk, Peter J Millett
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引用次数: 0

Abstract

Tendon transfers represent a reconstructive option for irreparable rotator cuff tears and certain neurologic deficiencies. Arthroscopically assisted lower trapezius tendon (aLTT) transfer using Achilles tendon allograft is effective in restoring external rotation and relieving excessive loading on the teres minor. It has shown good results in patients with brachial plexus injuries and posterosuperior irreparable rotator cuff tears. Isolated infraspinatus musculotendinous tears present distinct characteristics compared with other rotator cuff tears, as these lesions cause rapid atrophy and significant fatty infiltration within the muscle, making direct surgical repair less feasible. Tears of the infraspinatus tendon usually are associated with other rotator cuff injuries but can be isolated injuries, and tear at the musculotendinous junction of the tendon is a less common. Existing literature predominantly focuses on nerve-related causes of infraspinatus deficiency, such as in Parsonage-Turner syndrome or suprascapular nerve entrapment, which may be secondary to ganglion cysts along the nerve's path as well as other space-occupying lesions like tumors or vascular malformations. Infraspinatus muscle tendon injuries also can result from steroid injections and lead to severe pain and weakness during external rotation. Primary repair of the tear is a first choice if nonsurgical treatment is unsuccessful and if tear morphology and fatty infiltration allow. However, repair has a low success rate because of the aforementioned features. For older, low-demand patients, subacromial debridement or the use of a biodegradable subacromial balloon spacer can provide pain relief and functional improvement. In younger, more active patients, aLTT transfer using Achilles tendon allograft, although technically demanding and uncommonly performed, is a durable solution for this pathology when glenohumeral osteoarthritis and joint arthropathy are absent, offering sustained benefits at midterm follow-up. Other alternatives include latissimus dorsi tendon transfer, lower trapezius transfer (which may be biomechanically superior to latissimus dorsi tendon transfer), and reverse total shoulder arthroplasty. We thus consider aLTT to be a strong option for the right patient, performed by a skilled surgeon who can execute the procedure properly.

关节镜下使用同种异体跟腱移植治疗孤立的、不可修复的棘下肌腱撕裂是持久的。
肌腱转移是不可修复的肩袖撕裂和某些神经缺陷的重建选择。关节镜辅助下使用同种异体跟腱进行下斜方肌腱(aLTT)转移是恢复外旋和减轻小圆肌过度负荷的有效方法。它在臂丛损伤和后上不可修复的肩袖撕裂患者中显示出良好的效果。与其他肌腱套撕裂相比,孤立性冈下肌腱撕裂具有明显的特征,因为这些病变会导致肌肉迅速萎缩和显著的脂肪浸润,使得直接手术修复不太可行。冈下肌腱的撕裂通常与其他肌腱套损伤有关,但也可能是孤立的损伤,肌腱肌肉连接处的撕裂不太常见。现有文献主要集中于冈下肌缺乏的神经相关原因,如帕森纳-特纳综合征或肩胛上神经卡压,其可能继发于沿神经路径的神经节囊肿以及其他占位性病变,如肿瘤或血管畸形。类固醇注射也可导致冈下肌肌腱损伤,并在外旋时导致剧烈疼痛和无力。如果非手术治疗失败,如果撕裂形态和脂肪浸润允许,撕裂的初级修复是首选。然而,由于上述特点,修复成功率较低。对于年龄较大,需求低的患者,肩峰下清创或使用可生物降解的肩峰下球囊垫片可以缓解疼痛并改善功能。在更年轻、更活跃的患者中,使用同种异体跟腱移植术进行aLTT转移,尽管在技术上要求很高且很少进行,但在没有盂肱骨关节炎和关节病变的情况下,这是一种持久的解决方案,在中期随访中提供了持续的益处。其他选择包括背阔肌肌腱转移(LDTT),下斜方肌转移(生物力学上优于LDTT)和反向全肩关节置换术。因此,我们认为aLTT对合适的患者来说是一个强有力的选择,由熟练的外科医生正确执行手术。
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来源期刊
CiteScore
9.30
自引率
17.00%
发文量
555
审稿时长
58 days
期刊介绍: Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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