腱板広範囲断裂に対する挙上位後方アプローチを用いたPatte法 (棘下筋前進術) の1例

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We wish to report on a case of massive rotator cuff tear treated by Pattes procedure using the posterior subdeltoid approach on elevation position for the sake of a less invasive transposition of the infraspinatus.The patient was a 67-year-old man unable to elevate his right arm after work using a vibration tool. He could abduct his right arm 30 degrees best. Radiographs showed the shortening of the acromiohumeral interval (4mm). T2-weighted MRI showed a massive rotator cuff tear ; the end of the supraspinatus tendon shortened by 1cm medially from the glenoidal edge. The shoulder score was 68.5 points assessed by the Japanese Orthopedic Association. The operation was performed in the decubitus position. At first, we tried a conventional open cuff repair. Unfortunately, the cuff was too short to cover the humeral head ; therefore we shifted the infraspinatus using posterior subdeltoid approach on elevation position to avoid detaching the deltoid muscle. An abduction brace (70°) was used for 6 weeks. ROM exercises started passively after 4 weeks and actively after 8 weeks. At 6 months after the operation, his shoulder improved ; active elevation (150°), 92 points (JOA score). We experienced only one case, but Pattes procedure using a posterior subdeltoid approach on elevation position may be less invasive, less painful, and useful for severe cuff tear patients.