Accelerating Efficiency in Arthroscopically Assisted Lower Trapezius Transfer: How Can We Shorten the Learning Curve?

Area of Science:

• Orthopedic Surgery
• Shoulder Reconstruction
• Minimally Invasive Techniques

Background:

• Arthroscopic lower trapezius tendon transfer (aLTT) is a key procedure for massive rotator cuff tears, restoring posterior rotator cuff function.
• Despite its efficacy, aLTT presents technical challenges and a poorly defined learning curve.
• This study addresses the need to establish objective metrics for surgical proficiency in aLTT.

Purpose of the Study:

• To define the learning curve for arthroscopic lower trapezius tendon transfer (aLTT).
• To correlate surgical experience with operative time, functional outcomes, and complication rates.
• To identify the number of cases required to achieve proficiency in aLTT.

Main Methods:

• A case series of 39 patients undergoing primary aLTT was analyzed.
• Surgical times, range of motion, American Shoulder and Elbow Surgeon (ASES) scores, subjective shoulder value (SSV), and visual analog scale (VAS) pain scores were recorded.
• Linear regression and cumulative sum (CUSUM) analyses were used to determine the learning curve based on surgical time.

Main Results:

• A linear decrease in surgical time was observed throughout the study.
• CUSUM analysis indicated a learning curve of 14 patients.
• No significant differences in range of motion or ASES/SSV scores were found between the learning and proficiency phases, but VAS pain scores decreased in the proficiency phase.

Conclusions:

• Arthroscopic lower trapezius tendon transfer (aLTT) demonstrates a clear learning curve, with approximately 14 cases needed to exit the initial learning phase.
• Surgical proficiency, indicated by reduced operative time, was achieved without compromising key postoperative outcomes.
• Further research is warranted to identify optimal metrics for assessing proficiency in aLTT.