Zeigt der Latissimus-dorsi-Transfer als Revisionsoperation vergleichbare Ergebnisse zum Primäreingriff? Eine retrospektive Matched-Pair-Analyse

Zusammenfassung

Studienziel: Der Latissimus-dorsi-Transfer (LdT) wird bei nicht rekonstruierbaren posterosuperioren Rotatorenmanschettenrupturen durchgeführt. Ziel der retrospektiven Studie ist nun, die Frage zu klären, ob sich der Latissimus-dorsi-Transfer als Revisionseingriff bei fehlgeschlagener Rotatorenmanschettenrekonstruktion eignet. Methode: Zwischen 1998 und 2005 wurden 124 Patienten mittels Latissimus-dorsi-Transfer versorgt. Hieraus wurden 34 Patienten (Gruppe 1: sekundärer LdT n = 17, Gruppe 2: primärer LdT n = 17) anhand einer retrospektiven Matched-Pair-Studie nach einem mittleren Zeitraum von 20 Monaten (Gruppe 1) bzw. 28 Monaten (Gruppe 2) klinisch und radiologisch nachuntersucht. Funktionelle Ergebnisse wurden mit dem alters- und geschlechtskorrelierten Constant Score (CS) erhoben. Ergebnisse: Es zeigte sich eine signifikante Verbesserung des alters- und geschlechtskorrigierten Constant Scores in beiden Gruppen von präoperativ Gruppe 1 = 51 % und Gruppe 2 = 57 % auf postoperativ Gruppe 1 = 73 % und Gruppe 2 = 84 % (p = 0,001 bzw. p = 0,007). Im Gruppenvergleich liegt ein signifikant höherer postoperativer CS für Gruppe 2 vor (p = 0,03), bei nicht signifikanten Unterschieden präoperativ (p = 0,6). Die aktive Beweglichkeit zeigte postoperativ keine signifikanten Unterschiede (Abd/Flex p = 0,8). Das Hornblower-Sign war in Gruppe 1 signifikant häufiger positiv (p < 0,001). Der Vergleich der arthroskopisch zu den offen voroperierten Patienten zeigt einen Trend des postoperativen CS von 82 %/69 % (p = 0,06) zugunsten der Patienten mit vorangegangener Arthroskopie bei einem präoperativen relativen CS von 50 %/52 % (p = 0,9). Es zeigte sich keine vermehrte Komplikationsrate in der Revisionsgruppe. Schlussfolgerung: Bei korrekter Indikation liegen nach Latissimus-dorsi-Transfer als Primär- sowie als Revisionseingriff keine Unterschiede der Schmerzlinderung sowie der aktiven ROM vor. Jedoch zeigte sich ein signifikant geringerer relativer CS in Gruppe 1 sowie ein signifikant häufiger positives Hornblower-Sign. Eine erhöhte Komplikationsrate konnte nicht festgestellt werden. Der Latissimus-dorsi-Transfer ist aus unserer Sicht als Revisionseingriff geeignet.

Abstract

Aim: Latissimus dorsi transfer (LdT) has been proposed for the treatment of irreparable rotator cuff tears of the infra- and supraspinatus. The purpose of this retrospective study was to evaluate the results of latissimus dorsi transfer in revision surgery in comparison to primary surgery. Method: Between 1998 and 2005 a group of 124 patients has been treated with a latissimus dorsi transfer. From this group 34 patients (Group 1 = revision LdT n = 17, Group 2 = primary LdT n = 17) were examined in a retrospective matched-pair study after an average follow-up of 20 months (Group 1) and 28 months (Group 2) by clinical examination and X‐ray. Functional results were assessed with use of the age- and gender-matched Constant Score (CS). Results: The age- and gender-matched Constant Score increased significantly in both groups from preoperatively 51 % in Group 1 and 57 % in Group 2 up to a postoperative score of 73 % in Group 1 and 84 % in Group 2 (p = 0.001/p = 0.007). By comparison of the 2 groups there is a significantly higher postoperative age- and gender-matched Constant Score for Group 2 (p = 0.03). Active ROM showed postoperatively no significant difference (Abd/Flex p = 0.8). The Hornblower sign is significantly more frequently positive in Group 1 (p < 0.001). The comparison of arthroscopically and open previous surgery for the subgroups of revision latissimus dorsi transfer shows a trend for an increased postoperative age- and gender-matched Constant Score in the arthroscopic group (82 %/69 % p = 0.06) with a preoperative CS of 50 %/52 % (p = 0.9). There is no significant difference in the incidence of postoperative complications. Conclusion: Considering the correct indication for latissimus dorsi transfer there is no difference for reduction of pain and active ROM between primary and revision surgery. But the revision cases show a significantly lower age- and gender-matched Constant Score and a higher incidence of a positive Hornblower sign. A higher risk of postoperative complications for the revision group could not be found. In summary, the latissimus dorsi transfer was of significant benefit for both groups and we can also recommend this technique for revision surgery.

Schlüsselwörter

Latissimus‐dorsi‐Transfer - Rotatorenmanschettenruptur - Revision - Reruptur

Key words

latissimus dorsi transfer - rotator cuff - revision surgery - retear

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