Early Efficacy Assessment of Arthroscopic Lower Trapezius Transfer With Tendon Autograft in the Management of Massive Irreparable Posterosuperior Rotator Cuff Tears

Abstract

Objectives: To explore the indications and surgical techniques for arthroscopic lower trapezius transfer (LTT) with tendon autograft in managing massive irreparable posterosuperior rotator cuff tears (PSRCTs); to validate the feasibility, safety, and efficacy of this technique.Methods: This study retrospectively enrolled 23 patients with massive irreparable PSRCTs, admitted to and followed up by the Taizhou Hospital of Zhejiang province between July 2020 and April 2021, and treated with ipsilateral LTT and ipsilateral hamstring tendon autograft. The control group consisted of 23 patients with massive RCTs receiving conventional repair procedures within the same frame. Follow-up data at the preoperative visit, and postoperative month 3 were collected to assess the active range of motion, Constant–Murley Score (CMS),American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), University of California, Los Angeles (UCLA)shoulder score, visual analog scale (VAS)and the post-operative MRI results, all of which could provide a comprehensive postoperative early efficacy assessment.Results: Three months follow-up visits were completed for all patients, revealing improvements in all aspects compared to the preoperative state, with no complications, such as postoperative infection of surgical sites and nerve injuries of infection and nerve injury. The distribution of active shoulder range of motion of patients and function scores with two types of operation was as follow: angles of flexion and lifting (130.00° ± 31.55° vs. 90.78° ± 19.85°), abduction (123.26° ± 30.47°vs. 85.87° ± 18.74°), external rotation at side (101.74° ± 14.74° vs. 91.74° ± 11.92°), external rotation at 90° abduction (41.52° ± 21.97° vs. 24.57° ±12.60°), VAS (0.74± 0.81 vs. 1.87 ±0.87), CMS(56.3 ± 13.01 vs. 48.30 ± 8.38), UCLA shoulder score (24.04 ± 2.88 vs.20.96 ± 3.47), ASES (72.91 ± 9.99 vs.60.74 ± 8.84). Significantly better improvements were found in the study group on month 3.19 of 23 patients in the study group and 17 of 23 patients in the control group underwent MRI on the 3 months follow up. Retear was found in only one patient who had grade 4 subscapularis tendon injury, However, revision was not performed due to postoperative pain relief and functional improvement.Conclusion: Compared to conventional repair procedures, in the early postoperative period, LTT with tendon autograft could achieve better pain relief, more rapid motor functional recovery, and higher functional scores for massive irreparable PSRCTs.

Physiological Tensioning During Lower Trapezius Transfer for Irreparable Posterosuperior Rotator Cuff Tears May Be Important for Improvement in Shoulder Kinematics

“…Recently, lower trapezius transfer (LTT) has come to the fore as a promising joint-preserving treatment option for young and active patients with irreparable posterosuperior rotator cuff tears (PSRCTs). 8 , 13 , 31 , 33 , 36 Alternative surgical approaches include debridement, biceps tenotomy or tenodesis, partial repair, latissimus dorsi transfer, superior capsular reconstruction, subacromial balloon spacer, and reverse total shoulder arthroplasty, without clear evidence-based guidelines described in the literature. 20 As the line of pull of LTT is almost parallel to that of the native infraspinatus muscle, it holds the ideal anatomic position for restoring an insufficient anteroposterior muscular force couple.…”

“… 8 , 13 , 31 , 33 However, the fact that the lower trapezius is a relatively weak muscle with only a short excursion poses a clinical challenge, as it requires the interposition of a graft to bridge the gap to the insertion site. 15 , 18 , 28 Current options for interposition involve the use of an Achilles tendon allograft 13 , 14 , 31 or hamstring tendon autograft 33 , 36 to prevent excessive strain on the transferred trapezius muscle.…”