Abstract：
BACKGROUND: Reverse shoulder arthroplasty (RSA) with concurrent latissimus dorsi transfer (LDT) is a potential treatment option for restoration of external rotation (ER). Biomechanical studies have emphasized the importance of the insertion site location for achieving optimal outcomes. In this systematic review and meta-analysis, we aimed to describe what insertion sites for LDT are utilized during concomitant RSA and their associated clinical outcomes.
METHODS: A systematic review and meta-analysis were performed per PRISMA guidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting on patients who received RSA with LDT to restore ER and specified the site of tendon transfer insertion on the humerus. We first describe reported insertion sites in the literature. Secondarily, we present preoperative and postoperative range of motion and Constant score for different insertion sites as well as reported complications.
RESULTS: Sixteen studies, analyzed as 19 separate cohorts (by insertion site and tendon-transfer), reporting on 264 RSAs with LDT (weighted mean age 66 years, follow-up 39 months, 61% female) were evaluated. Of these, 143 (54%) included a concomitant teres major transfer (LDT/TMT) and 121 (46%) were LDT-only. Fourteen cohorts (14/19, 74%) reported insertion at the posterolateral aspect of the greater tuberosity, four cohorts (4/19, 21%) reported insertion site at the lateral bicipital groove, and one cohort (1/19, 5%) reported separate LDT and TMT with insertion of the TMT to the posterolateral aspect of the greater tuberosity and LDT to the lateral bicipital groove. Meta-analysis revealed no differences in range of motion or Constant score based on humeral insertion site or whether the LDT was transferred alone or with TMT. Leading complications included dislocation, followed by infection and neuropraxia. No discernible correlation was observed between postoperative outcomes and the strategies employed for tendon transfer, prosthesis design, or subscapularis management.
CONCLUSIONS: The posterolateral aspect of the greater tuberosity was the most-utilized insertion site for LDT performed with RSA. However, in the current clinical literature, LDT with or without concomitant TMT result in similar postoperative ROM and Constant score regardless of insertion site. Analysis of various proposed transfer sites reinforce the ability of LDT with RSA to restore both FE and ER in patients with preoperative active elevation and external rotation loss. Meta-analysis revealed significant improvements in range of motion and Constant score regardless of humeral insertion site or whether the LDT was transferred alone or with TMT, although future studies are needed to determine whether an ideal tendon transfer technique exists.
METHODS: IV.
METHODS: A systematic review and meta-analysis were performed per PRISMA guidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting on patients who received RSA with LDT to restore ER and specified the site of tendon transfer insertion on the humerus. We first describe reported insertion sites in the literature. Secondarily, we present preoperative and postoperative range of motion and Constant score for different insertion sites as well as reported complications.
RESULTS: Sixteen studies, analyzed as 19 separate cohorts (by insertion site and tendon-transfer), reporting on 264 RSAs with LDT (weighted mean age 66 years, follow-up 39 months, 61% female) were evaluated. Of these, 143 (54%) included a concomitant teres major transfer (LDT/TMT) and 121 (46%) were LDT-only. Fourteen cohorts (14/19, 74%) reported insertion at the posterolateral aspect of the greater tuberosity, four cohorts (4/19, 21%) reported insertion site at the lateral bicipital groove, and one cohort (1/19, 5%) reported separate LDT and TMT with insertion of the TMT to the posterolateral aspect of the greater tuberosity and LDT to the lateral bicipital groove. Meta-analysis revealed no differences in range of motion or Constant score based on humeral insertion site or whether the LDT was transferred alone or with TMT. Leading complications included dislocation, followed by infection and neuropraxia. No discernible correlation was observed between postoperative outcomes and the strategies employed for tendon transfer, prosthesis design, or subscapularis management.
CONCLUSIONS: The posterolateral aspect of the greater tuberosity was the most-utilized insertion site for LDT performed with RSA. However, in the current clinical literature, LDT with or without concomitant TMT result in similar postoperative ROM and Constant score regardless of insertion site. Analysis of various proposed transfer sites reinforce the ability of LDT with RSA to restore both FE and ER in patients with preoperative active elevation and external rotation loss. Meta-analysis revealed significant improvements in range of motion and Constant score regardless of humeral insertion site or whether the LDT was transferred alone or with TMT, although future studies are needed to determine whether an ideal tendon transfer technique exists.
METHODS: IV.
摘要：
背景：反向肩关节置换术（RSA）并发背阔肌转移（LDT）是恢复外旋（ER）的潜在治疗选择。生物力学研究强调了插入部位位置对于获得最佳结果的重要性。在这篇系统综述和荟萃分析中，我们的目的是描述哪些LDT插入位点在合并RSA期间被利用,以及它们相关的临床结局.
方法：根据PRISMA指南进行系统评价和荟萃分析。我们查询了PubMed/MEDLINE,Embase,WebofScience,和Cochrane数据库，以确定报告接受LDTRSA以恢复ER的患者的文章，并指定肱骨肌腱转移插入部位。我们首先描述了文献中报道的插入位点。其次，我们介绍了不同插入部位的术前和术后活动范围和Constant评分,以及报告的并发症.
结果：16项研究，分析为19个单独的队列（通过插入部位和肌腱转移），报告264个LDT注册会计师(加权平均年龄66岁，随访39个月,61%的女性）进行了评估。其中,143（54％）包括伴随的大圆转移（LDT/TMT）和121（46％）仅LDT。14个队列（14/19，74％）报告在大结节的后外侧插入，四个队列（4/19，21％）报告了外侧二头肌沟的插入部位，一个队列（1/19，5％）报告了单独的LDT和TMT，其中TMT插入了大结节的后外侧，LDT插入了外侧二头肌沟。荟萃分析显示，根据肱骨插入部位或LDT是单独还是与TMT一起转移，运动范围或Constant评分没有差异。主要的并发症包括脱位，然后是感染和神经兴奋。术后IR与肌腱转移策略之间没有明显的相关性，假体设计,或肩胛骨下管理。
结论：大结节的后外侧是用RSA进行LDT的最常用插入位点。然而,在目前的临床文献中，有或没有伴随的TMT的LDT导致相似的术后ROM和Constant评分，无论插入部位如何。对各种建议的转移部位的分析增强了LDT与RSA在术前主动抬高和外部旋转损失的患者中恢复FE和ER的能力。荟萃分析显示，无论肱骨插入部位或LDT单独或与TMT一起转移，运动范围和Constant评分均有显着改善。尽管需要未来的研究来确定是否存在理想的肌腱转移技术。
方法：IV.
方法：根据PRISMA指南进行系统评价和荟萃分析。我们查询了PubMed/MEDLINE,Embase,WebofScience,和Cochrane数据库，以确定报告接受LDTRSA以恢复ER的患者的文章，并指定肱骨肌腱转移插入部位。我们首先描述了文献中报道的插入位点。其次，我们介绍了不同插入部位的术前和术后活动范围和Constant评分,以及报告的并发症.
结果：16项研究，分析为19个单独的队列（通过插入部位和肌腱转移），报告264个LDT注册会计师(加权平均年龄66岁，随访39个月,61%的女性）进行了评估。其中,143（54％）包括伴随的大圆转移（LDT/TMT）和121（46％）仅LDT。14个队列（14/19，74％）报告在大结节的后外侧插入，四个队列（4/19，21％）报告了外侧二头肌沟的插入部位，一个队列（1/19，5％）报告了单独的LDT和TMT，其中TMT插入了大结节的后外侧，LDT插入了外侧二头肌沟。荟萃分析显示，根据肱骨插入部位或LDT是单独还是与TMT一起转移，运动范围或Constant评分没有差异。主要的并发症包括脱位，然后是感染和神经兴奋。术后IR与肌腱转移策略之间没有明显的相关性，假体设计,或肩胛骨下管理。
结论：大结节的后外侧是用RSA进行LDT的最常用插入位点。然而,在目前的临床文献中，有或没有伴随的TMT的LDT导致相似的术后ROM和Constant评分，无论插入部位如何。对各种建议的转移部位的分析增强了LDT与RSA在术前主动抬高和外部旋转损失的患者中恢复FE和ER的能力。荟萃分析显示，无论肱骨插入部位或LDT单独或与TMT一起转移，运动范围和Constant评分均有显着改善。尽管需要未来的研究来确定是否存在理想的肌腱转移技术。
方法：IV.
