Abstract：
BACKGROUND: This study aims to analyze the mid-to long-term results of the latissimus dorsi tendon for the treatment of massive posterosuperior irreparable rotator cuff tears as reported in high-quality publications and to determine its efficacy and safety.
METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and EMBASE databases were searched until December 2022 to identify studies with a minimum 4 year follow-up. Clinical and radiographic outcomes, complications, and revision surgery data were collected. The publications included were analyzed quantitatively using the DerSimonian Laird random-effects model to estimate the change in outcomes from the preoperative to the postoperative condition. The proportion of complications and revisions were pooled using the Freeman-Tukey double arcsine transformation.
RESULTS: Of the 618 publications identified through database search, 11 articles were considered eligible. A total of 421 patients (432 shoulders) were included in this analysis. Their mean age was 59.5 ± 4 years. Of these, 277 patients had mid-term follow-up (4-9 years), and 144 had long-term follow-up (more than 9 years). Postoperative improvements were considered significant for the following outcome parameters: Constant-Murley Score (0-100 scale), with a mean difference (MD) = 28 points (95% confidence interval [CI] 21, 36; I2 = 89%; P < .001); visual analog scale, with a standardized MD = 2.5 (95% CI 1.7, 3.3; P < .001; I2 = 89%; P < .001); forward flexion, with a MD = 43° (95% CI 21°, 65°; I2 = 95% P < .001); abduction, with a MD = 38° (95% CI 20°, 56°; I2 = 85%; P < .01), and external rotation, with a MD = 8° (95% CI 1°, 16°; I2 = 87%; P = .005). The overall reported mean complication rate was 13% (95% CI 9%, 19%; I2 = 0%), while the reported mean revision rate was 6% (95% CI: 3%, 9%; I2 = 0%).
CONCLUSIONS: Our pooled estimated results seem to indicate that latissimus dorsi tendon transfer significantly improves patient-reported outcomes, pain relief, range of motion, and strength, with modest rates of complications and revision surgery at mid-to long-term follow-up. In well-selected patients, latissimus dorsi tendon transfer may provide favorable outcomes for irreparable posterosuperior cuff tears.
METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and EMBASE databases were searched until December 2022 to identify studies with a minimum 4 year follow-up. Clinical and radiographic outcomes, complications, and revision surgery data were collected. The publications included were analyzed quantitatively using the DerSimonian Laird random-effects model to estimate the change in outcomes from the preoperative to the postoperative condition. The proportion of complications and revisions were pooled using the Freeman-Tukey double arcsine transformation.
RESULTS: Of the 618 publications identified through database search, 11 articles were considered eligible. A total of 421 patients (432 shoulders) were included in this analysis. Their mean age was 59.5 ± 4 years. Of these, 277 patients had mid-term follow-up (4-9 years), and 144 had long-term follow-up (more than 9 years). Postoperative improvements were considered significant for the following outcome parameters: Constant-Murley Score (0-100 scale), with a mean difference (MD) = 28 points (95% confidence interval [CI] 21, 36; I2 = 89%; P < .001); visual analog scale, with a standardized MD = 2.5 (95% CI 1.7, 3.3; P < .001; I2 = 89%; P < .001); forward flexion, with a MD = 43° (95% CI 21°, 65°; I2 = 95% P < .001); abduction, with a MD = 38° (95% CI 20°, 56°; I2 = 85%; P < .01), and external rotation, with a MD = 8° (95% CI 1°, 16°; I2 = 87%; P = .005). The overall reported mean complication rate was 13% (95% CI 9%, 19%; I2 = 0%), while the reported mean revision rate was 6% (95% CI: 3%, 9%; I2 = 0%).
CONCLUSIONS: Our pooled estimated results seem to indicate that latissimus dorsi tendon transfer significantly improves patient-reported outcomes, pain relief, range of motion, and strength, with modest rates of complications and revision surgery at mid-to long-term follow-up. In well-selected patients, latissimus dorsi tendon transfer may provide favorable outcomes for irreparable posterosuperior cuff tears.
摘要：
背景：本研究旨在分析高质量出版物报道的背阔肌肌腱治疗大量后上不可修复的肩袖撕裂的中长期结果，并确定其疗效和安全性。
方法：根据PRISMA指南进行系统评价。PubMed,Scopus,和EMBASE数据库检索至2022年12月,以确定至少4年随访的研究.临床和影像学结果，并发症,并收集翻修手术数据.使用DerSimonianLaird随机效应模型对纳入的出版物进行定量分析，以估计从术前到术后状况的结果变化。使用Freeman-Tukey双反正弦转换合并并发症和修订的比例。
结果：在通过数据库搜索确定的618种出版物中，11篇文章被认为是合格的。总共421名患者（432名肩膀）被纳入本分析。他们的平均年龄为59.5±4岁。其中,277例患者进行了中期随访（4至9年），144人进行了长期随访（超过9年）。术后改善被认为对以下结果参数有意义：Constant-Murley评分（0-100量表），平均差（MD）=28分（95％CI21，36；I2=89％；P<.001）；视觉模拟量表，标准MD=2.5(95CI1.7，3.3；P<.001；I2=89%；P<.001)；前屈，MD=43°(95%CI21°，65°;I2=95%P<.001);外展,MD=38°(95%CI20°,56°；I2=85%；P<.01），和外部旋转，MD=8°(95%CI1°，16°；I2=87%；P=.005）。总体报告的平均并发症率为13%(95%CI9%，19%；I2=0%），而报告的平均修订率为6%(95%CI：3%，9%；I2=0%）。
结论：我们的汇总估计结果似乎表明背阔肌肌腱转移显著改善了患者报告的结果，疼痛缓解,运动范围,和力量，在中长期随访中，并发症和翻修手术的发生率适中。在精心挑选的患者中，背阔肌肌腱转移可能为不可修复的后上袖带撕裂提供良好的结果。
方法：根据PRISMA指南进行系统评价。PubMed,Scopus,和EMBASE数据库检索至2022年12月,以确定至少4年随访的研究.临床和影像学结果，并发症,并收集翻修手术数据.使用DerSimonianLaird随机效应模型对纳入的出版物进行定量分析，以估计从术前到术后状况的结果变化。使用Freeman-Tukey双反正弦转换合并并发症和修订的比例。
结果：在通过数据库搜索确定的618种出版物中，11篇文章被认为是合格的。总共421名患者（432名肩膀）被纳入本分析。他们的平均年龄为59.5±4岁。其中,277例患者进行了中期随访（4至9年），144人进行了长期随访（超过9年）。术后改善被认为对以下结果参数有意义：Constant-Murley评分（0-100量表），平均差（MD）=28分（95％CI21，36；I2=89％；P<.001）；视觉模拟量表，标准MD=2.5(95CI1.7，3.3；P<.001；I2=89%；P<.001)；前屈，MD=43°(95%CI21°，65°;I2=95%P<.001);外展,MD=38°(95%CI20°,56°；I2=85%；P<.01），和外部旋转，MD=8°(95%CI1°，16°；I2=87%；P=.005）。总体报告的平均并发症率为13%(95%CI9%，19%；I2=0%），而报告的平均修订率为6%(95%CI：3%，9%；I2=0%）。
结论：我们的汇总估计结果似乎表明背阔肌肌腱转移显著改善了患者报告的结果，疼痛缓解,运动范围,和力量，在中长期随访中，并发症和翻修手术的发生率适中。在精心挑选的患者中，背阔肌肌腱转移可能为不可修复的后上袖带撕裂提供良好的结果。
