腱板広範囲断裂例に対する L'Episcopo 変法の小経験

概要

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Background: Some elderly patients with massive rotator cuff tears have weakness in shoulder abduction and external rotation. Many surgical treatment approaches have been attempted for this clinical problem. Tendon transfer is an option that improves active external rotation. In 1934, L'Episcopo described the use of combined teres major and latissimus dorsi tendon transfers in cases of pediatric high brachial plexus palsy. Methods: This study reports the clinical result of modified L'Episcopo procedure associated with arthroscopic partial repair for massive rotator cuff tears. We examined 5 cases. The average age was 73.8 years old, and mean follow-up period was 11.2 months. All cases were male with dominant side injury. Clinical results were evaluated with JOA scores of pre and post operation. Results: Postoperatively, 4 patients improved the function of external rotation. JOA scores were improved postoperatively, from 61.0 points to 78.6 points. The mean active flexion increased from 113° to 134°, and mean external rotation increased from -16 °to 7°. But there was an unsatisfactory result for one of our patients. The reason may be late rupture of the graft or soft tissue adhesion that hindered the excursion of the transferred musculotendinous unit. Conclusion: L'Episcopo procedure is an effective treatment for external rotation deficit of the shoulder. The rerouted musculotendinous unit acts as an external rotator.