Les auteurs ont revu 41 lambeaux deltoïdiens réalisés pour ruptures chroniques irréparables de la coiffe des rotateurs. Aucun patient n'a été perdu de vue au recul moyen de 7 ans. Le tendon du supraspinatus était rétracté à la glène dans 83 % des cas et il existait toujours une extension antérieure ou postérieure de la rupture. Trente-huit patients (92 %) restaient satisfaits au recul final avec une progression du score de Constant brut de 37 à 62 points. La flexion antérieure moyenne est passée de 113° à 148°, et la force de flexion de 1,3 kg à 2,9 kg. Lorsque la flexion préopératoire était inférieure à 90° (11 cas), le gain moyen était de + 89°. A l'inverse, 7 des 18 patients qui présentaient une flexion supérieure à 120°, ont perdu en moyenne 40° au recul final. Vingt-sept patients ont bénéficié de 2 revues systématiques (reculs : 12 et 89 mois) démontrant le maintien du résultat sur la douleur et la progression du résultat sur la force. L'espace sous-acromial radiologique (ESA), mesuré dans 88 % des cas, est passé de 7,3 mm à 5,5 mm. Dans 20 cas (56 %), l'ESA s'est aggravé et aucun ESA ne s'est amélioré. Le lambeau a été contrôlé par 7 échographies et 1 IRM objectivant un taux de 50 % de lambeaux continus et épais de plus de 4 mm. Le lambeau deltoïdien peut être indiqué en cas de rupture irréparable chez un patient en bon état physiologique.

The aim of this study was to assess outcome after deltoid muscle flap repair of massive rotator cuff tears. We examined functional and radiological results at least five years after surgery.

We reviewed 41 shoulders operated by three senior surgeons (MC, DK, HT). None of the patients were lost to follow-up. The global Constant score was used for pre- and postoperative functional assessment. Three groups were distinguished by preoperative active flexion (group I < 90°, group II 90°-120°, group III > 120°). AP, double oblique (3 rotation views to measure the subacromial space), and Lamy lateral radiographs were obtained in all patients. Shoulder anatomy was evaluated at last follow-up in eight patients: magnetic resonance imaging (MRI) because of persistent pain in one patient and ultrasonography performed by one radiologist (NC) in seven patients.

The study population included 26 men and 15 women, mean age at surgery 59 years (42-78, 8). Mean follow-up was 7 years (5-8.5, 0.9). In the coronal plane, there were no distal tears, the stump was in an intermediate position in 7 cases (17%) and retracted to the glenoid in 34 (83%). In the sagittal plane, the supraspinatus exhibited a full thickness tear in all cases. The tear extended anteriorly or posteriorly in all cases. Thirty-eight patients (92%) were satisfied at last follow-up; their global Constant score had improved from 37 to 62 points. Mean anterior flexion improved from 113° to 148° and flexion force from 1.3 kg to 2.9 kg. When preoperative flexion was less than 90° (11 cases), mean gain was + 89°. Inversely, 7 of the 18 patients with flexion > 120° lost a mean 40° at last follow-up. Twenty-seven patient were reviewed at 12 and 89 months: pain relief and force were maintained. The subacromial space, measured in 88% of the cases, was 7.3 mm preoperatively and 5.5 mm at last follow-up. The subacromial space narrowed in 20 patients (56%); none of the patients exhibited an improvement. The flap was explored by ultrasonography in seven patients and by MRI in one: the flap was continuous in 50% and measured more than 4 mm in thickness. Reviews at 12 then 89 months demonstrated good maintenance of pain relief and progression of active flexion and force.

This long-term study confirms the usefulness of the deltoid flap for the treatment of full thickness massive tears of the rotator cuff. The flap provides persistent pain relief and good function and force. This technique should be discussed for young patients in good physical condition when preoperative imaging demonstrates and irreparable alteration of the tendinomuscular structures (supraspinatus retraction, fatty degeneration, severe amyotrophy). The technique is particularly useful when preoperative flexion is less than 90°. Although the population size is too small for statistical analysis, indications for deltoid flap repair should probably be limited to tears involving at most two tendons and sparing the subscapularis.