Lower trapezius transfer with semitendinosus tendon augmentation: Indication, technique, results

Area of Science:

• Orthopedic Surgery
• Shoulder Reconstruction
• Rotator Cuff Repair

Background:

• Lower trapezius transfer is a known technique for restoring external rotation in brachial plexus palsies.
• Some patients with cuff tear arthropathies present with limited active external rotation but preserved forward elevation.
• This study investigates a modified lower trapezius transfer technique for irreparable posterosuperior rotator cuff tears.

Purpose of the Study:

• To evaluate the clinical outcomes of a novel lower trapezius transfer procedure.
• The modification involves extending the transfer with a semitendinosus tendon and arthroscopic fixation to the infraspinatus insertion.
• To assess improvements in active external rotation, shoulder function, and pain levels.

Main Methods:

• 14 patients (mean age 62) with irreparable posterosuperior rotator cuff tears underwent the modified lower trapezius transfer between 2013 and 2016.
• The procedure involved harvesting the lower trapezius with a semitendinosus tendon graft and arthroscopically fixing it to the infraspinatus insertion.
• Outcomes were assessed using the Constant-Murley score, Simple Shoulder Test (SST), and Subjective Shoulder Value (SSV).

Main Results:

• Over a mean 24-month follow-up, patients achieved significant gains in external rotation (24° at side, 40° at 90° abduction).
• Functional scores improved: Constant-Murley (35 to 60), SST (3.5 to 7.5), and SSV (30 to 60%).
• Pain decreased significantly (VAS 7 to 2), and lag signs were negative; two complications (hematoma, infection) occurred.

Conclusions:

• Lower trapezius transfer, augmented with a semitendinosus tendon, is a promising option for irreparable posterosuperior cuff tears.
• The procedure successfully restores active external rotation and improves shoulder function and pain.
• Patients maintain active anterior elevation, making it a valuable therapeutic choice.