抄録
There is no consensus of the surgical method for a massive rotator cuff tear that can not be repaired by McLaughlin's procedure. We performed reconstructive surgery with a tuberculum majus transfer (Tm transfer) as reported by Paavolainen in such cases.
During the 7 years since 1989, we performed a Tm Transfer on 7 patients, of whom 6 (5 males and 1 female) were observed for 1 year or more and included in this study. The right side was affected in 5 patients and the left side in the other one. The age of the patients at the time of surgery was 47-76years (mean,62.8 years). The follow-up period was 13-86 months (mean,42 months). The massive cuff tear was complicated by a glenoid fracture of the scapula in case 1 and by a rupture of the long head of the biceps brachii in case 2.
Tm transfers alone were performed on 2 patients. Tm transfer was combined with a supraspinatus advancement (Debeyre) in 3 and with a trapezius transfer (Mikasa) in 1. In the patient with a glenoid fracture, osteosynthesis of the glenoid fracture was performed in combination with a modified Bristow's procedure. The postoperative results according to the JOA score and X-ray films were evaluated for these patients.
The mean JOA score before surgery was 44.2 points but markedly improved to 90.3 after surgery: pain, from 12.4 to 28.8; function, from 6.3 to 19.8; range of motion, from 11 to 22.7. The mean acromiohumeral interval increased from 7.4mm before the operation to 10.8mm after it.
We recommend the use of the rotator cuff itself in reconstructive surgery of massive cuff tears. The teres minor is often preserved even in a massive tear, and a Tm transfer using this muscle is useful.
