Objective: To present the arthroscopically assisted lower trapezius transfer technique that restores shoulder external rotation and forward elevation, with low complication rates and fast recovery. Indications: Massive irreparable posterosuperior rotator cuff tears in active young patients with fatty infiltration ≥ III, osteoarthrosis Hamada ≤ 3, normal function of lower trapezius, and without glenohumeral stiffness. Contraindications: Absolute: Active soft tissue infection and trapezius muscle paralysis. Relative: medical comorbidities, inability to follow postoperative recommendations, advanced age, advanced degenerative changes (Hamada > 3), deltoid deficiency, and forward elevation < 60º. Surgical technique: Beach chair position. Lower trapezius harvesting, allograft preparation, arthroscopic evaluation and rotator cuff partial repair, allograft passage, allograft intraarticular arthroscopic attachment, lower trapezius-allograft open attachment and wound closure.Postoperative management: Avoidance of internal rotation with an external rotation brace for 6 weeks. At 6 weeks progressively appropriate physical therapy. Unrestricted activity at 6 months. Results: At mean follow-up of 14 months, good results were reported (pain, range of motion, and Subjective Shoulder Value and Disabilities of the Arm and Shoulder and Hand scores). Long-term symptoms, Hamada 3 rotator cuff arthropathy, and true pseudo paralysis were associated with negative clinical outcomes, but subscapularis pathology and teres minor fatty atrophy were not. A low complication rate was described. Arthroscopically assisted lower trapezius transfer may restore motion and strength in external rotation. Good results with low complication rates have been reported. It has become the authors' procedure of choice in young active patients with irreparable massive rotator cuff tears. KeywordsIrreparable rotator cuff tears • Massive rotator cuff tear • Arthroscopic lower trapezius transfer • Shoulder tendon transfer • Shoulder reconstruction • Lower trapezius
RESUMEN Introducción: numerosos estudios han sido realizados en los últimos años con el objetivo de mejorar el conocimiento del ligamento anterolateral (LAL) de la rodilla. Debido a esto, se cree conveniente realizar esta revisión bibliográfica para definir la incidencia, la anatomía, la biomecánica, la clínica, las pruebas de imagen y el tratamiento del mismo. Material y métodos: se realiza una búsqueda en las bases de datos PubMed/Medline/Cochrane. Se incluyeron estudios descriptivos tanto clínicos como in vitro sobre las consideraciones anatómicas, biomecánicas, clínicas, estudios de imagen, manejo quirúrgico y resultados del LAL de la rodilla hasta abril de 2017. Se excluyen artículos no escritos en inglés, publicados en revistas no indexadas, no realizados en humanos o cadáveres humanos y aquellos no pertenecientes a la rodilla. Resultados: el origen femoral es el que más discusión nos ofrece, insertándose en la tibia entre el tubérculo de Gerdy y la cabeza del peroné. Biomecánicamente, parece influir en la estabilidad rotacional, con escaso control de la estabilidad anteroposterior. Para su diagnóstico, disponemos del pivot shift en la exploración, fractura de Segond en la radiología simple, ecografía y resonancia magnética.
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