Lower trapezius transfer for massive posterosuperior rotator cuff defects.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Shoulder Reconstruction

Background:

• Massive irreparable rotator cuff tears significantly impair shoulder function, particularly in active young patients.
• Traditional treatments may not adequately restore external rotation and forward elevation in these complex cases.
• The lower trapezius muscle offers potential for functional restoration due to its biomechanical properties.

Purpose of the Study:

• To detail the arthroscopically assisted lower trapezius transfer technique for irreparable rotator cuff tears.
• To evaluate the efficacy of this technique in restoring shoulder external rotation and forward elevation.
• To assess complication rates and recovery speed associated with the procedure.

Main Methods:

• Patient selection criteria included active young individuals with massive irreparable posterosuperior rotator cuff tears (fatty infiltration ≥ III, Hamada ≤ 3) and normal lower trapezius function.
• The surgical technique involved arthroscopic evaluation and partial rotator cuff repair, followed by harvesting and arthroscopic/open attachment of the lower trapezius allograft.
• Postoperative management included external rotation bracing for 6 weeks, followed by progressive physical therapy, with unrestricted activity at 6 months.

Main Results:

• At a mean follow-up of 14 months, patients reported good outcomes regarding pain, range of motion, and functional scores (Subjective Shoulder Value, Disabilities of the Arm and Shoulder and Hand).
• Low complication rates were observed.
• Arthroscopically assisted lower trapezius transfer demonstrated potential to restore motion and strength in external rotation.

Conclusions:

• The arthroscopically assisted lower trapezius transfer is an effective procedure for young, active patients with massive irreparable rotator cuff tears.
• The technique offers a favorable option for restoring shoulder function, characterized by good clinical outcomes and a low complication profile.
• This procedure has become the preferred choice for the authors in managing such challenging rotator cuff pathologies.