Доля повреждений вращательной манжеты плеча занимает одно из ведущих мест в структуре повреждений опорно-двигательного аппарата. История изучения данной патологии началась около 5 веков назад и продолжается по настоящее время. Однако попытки ввести общепринятую классификацию повреждений не увенчались успехом. С развитием научно-технического прогресса появилось множество методов консервативного и хирургического лечения. Среди консервативных методов лечения, направленных на уменьшение болевого синдрома и улучшение качества жизни, используются инъекции кортикостероидов, гиалуроновой кислоты, аутоплазмотерапия. Но, к сожалению, данные методы лечения не направлены на восстановление функции плечевого сустава. Хирургические методы лечения повреждений вращательной манжеты разнообразны. Это и классическая реинсерция повреждённого сухожилия, и артроскопические методы лечения. При массивных разрывах осуществляют реконструктивно-пластические операции с переносом сухожилий подостной, малой круглой или широчайшей мышцы спины, а также используют аутотрансплантаты или аллотрансплантаты. Однако, несмотря на большое количество методов лечения, чёткие алгоритмы ведения пациентов с данной патологией отсутствуют и процент неудовлетворительных исходов лечения остаётся высоким.

Rotator cuff ruptures are the most common injuries of shoulder joint with an incidence of about 20 %. This pathology is more common in adults over 60 years of age because it is caused by degenerative changes in the tendon. Massive injuries account for 10–40 % of all rotator cuff injuries. Currently, there is no unified surgical tactics for the treatment of patients with massive ruptures of rotator cuff tendons.The aim. To assess the efficiency of transposition of the latissimus dorsi tendon in patients with massive ruptures of the rotator cuff tendon.Materials and methods. The study included 15 patients with Patte stage III massive ruptures of the rotator cuff who had transposition of the latissimus dorsi tendon.Results. The article presents clinical cases of surgical treatment of patients. The following criteria were assessed: mean age; time since injury; duration of the surgery; blood loss volume; functional results by the ASES (American Shoulder and Elbow Surgeons) Shoulder Score. Taking into account the ASES Shoulder Score indicators 1 year after the surgical treatment, the following results were obtained: excellent results – in 9 (53.3 %) cases; good results – in 1 (13.4 %) case; satisfactory results – in 5 (33.3 %) cases.Conclusion. When preserving the articular cartilage, the method of choice in the treatment of patients with massive ruptures of rotator cuff tendons is transposition of the latissimus dorsi tendon. At the same time, an incomplete restoration of the function of the injured limb was registered in 33.3 % of patients, which requires further study and modification of the known method of transposition of the latissimus dorsi tendon.

Rotator cuff tears are the most common cause of shoulder pain and dysfunction in older patients. Tear with retraction greater than 5cm or with the involvement of two and more tendons are considered massive. According to the literature, the incidence of massive injuries of the rotator cuff ranges from 10 to 40%. The formation of massive injuries is a long process leading to a pronounced pain syndrome, loss of function and, as a result, to pseudo-paralysis of the affected limb. There is no consensus concerning the treatment of this category of patients. Conservative methods of treatment are applicable for patients with a low activity. Among the surgical methods of treatment, the preference is given to the proximal capsule reconstruction, subacromial balloon arthroplasty, reverse arthroplasty and muscle-tendon transfers. However, today there is no single tactic of surgical treatment of patients with rotator cuff massive tears. We propose a new surgical method for this shoulder joint pathology arthroscopically-associated transposition of the tendon of the latissimus dorsi muscle using an autograft of the long peroneal muscle tendon. As a description of the new method, we present a successful clinical case of the treatment of a patient with chronic massive rotator cuff injury of the right shoulder and secondary upper subluxation of the right humerus head. This method allows to increase the efficiency of treatment of a massive tear of the rotator cuff tendons, to restore the correct biomechanics of the shoulder joint, to reduce the pain and to restore the function of the affected limb.

Артроскопически-ассоциированная транспозиция широчайшей мышцы спины при лечении пациентов с массивными разрывами вращательной манжеты плеча (клинический случай)

The frequency of rotator cuff injuries in people over 45 years of age is 25.6–50 %, and  40  % of these injuries are massive. Shoulder rotator cuff injury causes disorders in biomechanics of the shoulder joint such as anterior-superior dislocation of the humeral head. Injury of the deltoid muscle combined with a massive rupture of the rotator cuff causes proximal dislocation of the humeral head during any active movement. In  the  treatment of these cases, surgical methods of treatment are used, such as transposition of the latissimus dorsi muscle, proximal capsule plasty, and reverse shoulder arthroplasty. We present a successful clinical case of treatment of a patient with chronic massive injury of the right shoulder joint rotator cuff tendons in combination with the injury of shoulder joint proximal capsule, dislocation of the right humerus head, and hypotrophy of the anterior portion of the deltoid muscle. We performed transposition of the latissimus dorsi tendon in combination with shoulder joint proximal capsule plasty with an autograft of the peroneal longus tendon. The check-up X-rays show that the dislocation of the right shoulder joint was eliminated. In the early postoperative period, the patient started physiotherapy exercises of the operated limb using abduction pillow. By the 7th day after surgery, the abduction of the operated limb reached 70°. The described surgical technique allows to restore congruence in the shoulder joint and the function of the injured limb in severe multiple injuries of the shoulder joint structures.