修復不能な腱板断裂に対する棘下筋腱 • 小円筋腱移行術の試み

概要

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The purpose of this study is to investigate the clinical results of open tendon transfer for global tear of rotator cuffs. We reviewed 11 shoulders that had rotator cuffs which could not reach at the top of the humeral head. Open acromioplasty and tendon transfer were done. The humeral heads were covered by tendon transfer of infraspinatus and teres minor. After repairing cuffs to bone trough, infraspinatus, teres minor, and supraspinatus tendon were sutured side to side. We sometimes avoided excessive tension of repaired cuffs by additional transfer of subscapularis tendon. The period of postoperative fixation was 6 weeks. The follow up period was 14.7 months. The JOA score (except the evaluation of the X-ray and the stability) was significantly improved from 43.8 preoperatively to 54.7 postoperatively. For 10 shoulders the MRI showed Type II in 3 cases, Type III in 2 cases and Type V in 5 cases by Sugaya classification. It was possible to cover the cartilage of the humeral head by tendon transfer of infraspinatus and teres minor by creating a bone trough more proximal of the foot print. However, 5 in 10 shoulders were considered as re-tear in MRI. This is one method for irreparable rotator cuff tears and it is possible to do it under arthroscopy, but it needs improvement of the suture technique.