Arthroscopic-Assisted Lower Trapezius Tendon Transfer for Massive Irreparable Posterosuperior Rotator Cuff Tears Using an Achilles Tendon-Bone Allograft

Abstract

The lower trapezius tendon (LTT) transfer has been described for the management of irreparable posterosuperior rotator cuff tears. Here we describe our technique of an arthroscopic-assisted LTT transfer using an Achilles tendon-bone allograft. This technique allows for augmentation of the tendon transfer using an Achilles tendon allograft while also keeping the calcaneal bone insertion, which allows for added bony fixation into the humerus and also minimizing the risk of the "killer turn" phenomenon at the aperture of fixation.

Arthroscopic-Assisted Lower Trapezius Tendon Transfer With Autologous Semitendinosus Tendon and Long Head of Biceps Superior Capsule Reconstruction for Massive Irreparable Posterosuperior Rotator Cuff Tears

“…Regarding the humerus tunnel drilling during the surgery, Valenti and Werthel 26 used a guiding device to create a bone tunnel from posterior of the infraspinatus footprint to the bicipital groove anteriorly, which the authors considered difficult because the guide might be too bulky. Ek et al 28 applied a guidewire passed from anterior to posterior, with the goal being that the pin exits at the upper part of native infraspinatus tendon insertion point, which might be a better solution to facilitate the surgery. We tenotomized the LHBT distally as Boutsiadis et al 11 proposed after LHBT SCR, which made drilling from the anterior to posterior part of the humerus easier because the whole bicipital groove was cleared after the proximal part of LHBT been rerouted posteriorly onto the footprint of supraspinatus.…”

Proximal humerus reconstruction in reverse total shoulder arthroplasty with proximal humeral bone loss using a lower trapezius tendon transfer with Achilles tendon-bone allograft: surgical technique and report of 2 cases

“…As previously described, 14 a 10-cm to 15-cm long oblique incision across the scapular spine towards the medial boarder of the scapula is performed ( Fig. 3 ).…”

The clinical results of lower trapezius tendon transfer with the peroneus longus allograft augmentation combined with interpositional repair with fascia lata in massive irreparable rotator cuff tears

“…Since the transfer is closer to the axis of motion of the posterior-superior rotator cuff muscles, the LT tendon can be harvested relatively easily, and the functional results are good, it has been increasingly preferred in the treatment of posterior-superior irreparable RCT. [8][9][10][11][12] In LT tendon transfer, since there is an irreparable massive rotator cuff tear, the humeral head cannot be fully covered and a gap is formed. Repairing the retracted tendon with the interpositional method provides closure of the gap, and makes the procedure more anatomical.…”

“…Since the transfer is closer to the axis of motion of the posterior-superior rotator cuff muscles, the LT tendon can be harvested relatively easily, and the functional results are good, it has been increasingly preferred in the treatment of posterior-superior irreparable RCT. 8 - 12 …”